Provider Demographics
NPI:1548449267
Name:ARENA, ANDREW J (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:ARENA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1779
Mailing Address - Country:US
Mailing Address - Phone:478-743-0047
Mailing Address - Fax:478-743-0792
Practice Address - Street 1:2410 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1779
Practice Address - Country:US
Practice Address - Phone:478-743-0047
Practice Address - Fax:478-743-0792
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00654805AMedicaid
T97493Medicare UPIN