# DR. ANDREW J PARK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063774693
- **Gender:** Man
- **Credential:** DC, MS, MS LAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X012187-1 | NY | Yes |
| 111NN1001X | Nutrition Chiropractor | X012187-1 | NY | — |
| 111NS0005X | Sports Physician Chiropractor | X012187 | NY | — |
| 171100000X | Acupuncturist | 004991 | NY | — |

## Other

- **Enumeration date:** 06/11/2012
- **Last updated:** 01/31/2013