Provider Demographics
NPI:1477814010
Name:ANDA CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:ANDA CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIRPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:ANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-367-6980
Mailing Address - Street 1:3369 39TH ST S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7542
Mailing Address - Country:US
Mailing Address - Phone:701-367-6980
Mailing Address - Fax:
Practice Address - Street 1:3369 39TH ST S
Practice Address - Street 2:SUITE 3
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7542
Practice Address - Country:US
Practice Address - Phone:701-367-6980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty