Provider Demographics
NPI:1871732560
Name:PROCITA, ANDREA T (DC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:PROCITA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 NH ROUTE 104
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256
Mailing Address - Country:US
Mailing Address - Phone:603-744-0480
Mailing Address - Fax:
Practice Address - Street 1:345 NH ROUTE 104
Practice Address - Street 2:SUITE 8
Practice Address - City:NEW HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03256-4244
Practice Address - Country:US
Practice Address - Phone:603-744-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5041097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor