Provider Demographics
NPI:1730245986
Name:PIAZZA, ANDREW C (DC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:C
Last Name:PIAZZA
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 1:40 E 1ST AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:TRAPPE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2031
Mailing Address - Country:US
Mailing Address - Phone:610-529-1206
Mailing Address - Fax:
Practice Address - Street 1:30 MIFFLIN BLVD
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2833
Practice Address - Country:US
Practice Address - Phone:610-775-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007828L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHIGHMARKOther737884
PA11366855OtherCAQH