Provider Demographics
NPI:1770758583
Name:ANDO, SEIICHIRO (DC, DACNB)
Entity type:Individual
Prefix:DR
First Name:SEIICHIRO
Middle Name:
Last Name:ANDO
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:201-496-6066
Mailing Address - Fax:201-496-6067
Practice Address - Street 1:725 RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1149
Practice Address - Country:US
Practice Address - Phone:201-496-6066
Practice Address - Fax:201-496-6067
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09784111NN0400X
NJ38MC00673300111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
165350OtherMEDICARE PTAN
165350YQJVOtherMEDICARE
276920YQJVOtherMEDICARE