Provider Demographics
NPI:1538240338
Name:MILNE, ANDREA
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MILNE
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MILNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 170156
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-0156
Mailing Address - Country:US
Mailing Address - Phone:817-572-0072
Mailing Address - Fax:
Practice Address - Street 1:4012 SW GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4113
Practice Address - Country:US
Practice Address - Phone:817-572-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5279111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
605588Medicare ID - Type Unspecified