Provider Demographics
NPI:1861587206
Name:TIO, ANDRE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:TIO
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 1:1328 W EL CAMINO REAL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2404
Mailing Address - Country:US
Mailing Address - Phone:650-969-8882
Mailing Address - Fax:
Practice Address - Street 1:1328 W EL CAMINO REAL
Practice Address - Street 2:SUITE 2
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2404
Practice Address - Country:US
Practice Address - Phone:650-969-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0255250Medicare ID - Type Unspecified