Provider Demographics
NPI:1053737486
Name:ANDREULA, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ANDREULA
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 1:5533 E BELL RD
Mailing Address - Street 2:STE 109
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1228
Mailing Address - Country:US
Mailing Address - Phone:602-788-4200
Mailing Address - Fax:602-788-4208
Practice Address - Street 1:5533 E BELL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1228
Practice Address - Country:US
Practice Address - Phone:602-788-4200
Practice Address - Fax:602-788-4208
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor