Provider Demographics
NPI:1225362569
Name:STEVENS, ANDROMEDA (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDROMEDA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ANDROMEDA
Other - Middle Name:
Other - Last Name:TRUMBULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:16430 VENTURA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2115
Mailing Address - Country:US
Mailing Address - Phone:818-788-8112
Mailing Address - Fax:818-788-8303
Practice Address - Street 1:16430 VENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2115
Practice Address - Country:US
Practice Address - Phone:818-788-8112
Practice Address - Fax:818-788-8303
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor