Provider Demographics
NPI:1780758847
Name:HORNSTEIN, ANDREA (DC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:HORNSTEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4414
Mailing Address - Country:US
Mailing Address - Phone:701-672-1300
Mailing Address - Fax:701-672-1301
Practice Address - Street 1:505 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4414
Practice Address - Country:US
Practice Address - Phone:701-672-1300
Practice Address - Fax:701-672-1301
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND748111N00000X
MN4548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13458Medicaid
ND025345OtherBS ND
NDV04560Medicare UPIN
NDN25345Medicare ID - Type Unspecified