Provider Demographics
NPI:1083772412
Name:STEWART, ANDREW LAWSON (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LAWSON
Last Name:STEWART
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 1:3249 MT DIABLO CT
Mailing Address - Street 2:STE 101B
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4069
Mailing Address - Country:US
Mailing Address - Phone:925-513-8883
Mailing Address - Fax:650-692-6237
Practice Address - Street 1:3249 MT DIABLO CT
Practice Address - Street 2:STE 101B
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4069
Practice Address - Country:US
Practice Address - Phone:925-513-8883
Practice Address - Fax:650-692-6237
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20806111N00000X
CA20806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-3143928OtherFED TAX ID
CADC0206080Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAU31004Medicare UPIN