Provider Demographics
NPI:1730789660
Name:DEARBORN, ANDREW PHILLIP
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILLIP
Last Name:DEARBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 BERING ST APT 401
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4674
Mailing Address - Country:US
Mailing Address - Phone:907-602-3687
Mailing Address - Fax:
Practice Address - Street 1:3310 BERING ST APT 401
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4674
Practice Address - Country:US
Practice Address - Phone:907-602-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157931111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation