Provider Demographics
NPI:1881966075
Name:PROST, ANDREA E (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:E
Last Name:PROST
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 1:103 MAR VISTA DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3502
Mailing Address - Country:US
Mailing Address - Phone:408-687-5044
Mailing Address - Fax:831-612-1859
Practice Address - Street 1:103 MAR VISTA DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3502
Practice Address - Country:US
Practice Address - Phone:408-687-5044
Practice Address - Fax:831-612-1859
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27844111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU90221Medicare UPIN