Provider Demographics
NPI:1730613498
Name:CHAN, ANDREW CHRISTOPHER
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:3727 SHOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-6202
Mailing Address - Country:US
Mailing Address - Phone:360-320-8389
Mailing Address - Fax:
Practice Address - Street 1:3727 SHOREWOOD AVE
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253-6202
Practice Address - Country:US
Practice Address - Phone:360-320-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer