Individual
DR. ANDREW C. INDRISO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1421 SPRUCE ST, PHILADELPHIA, PA 19102-4533
(215) 735-2997
(215) 735-5222
Mailing address
1421 SPRUCE ST, PHILADELPHIA, PA 19102-4533
(215) 735-2997
(215) 735-5222
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
DC 002452L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2237522000
IBC PROVIDER #
PA
Enumeration date
04/19/2007
Last updated
07/08/2007
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