Provider Demographics
NPI:1326141581
Name:VANDEWALLE, ALEXANDER C (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:VANDEWALLE
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 1:503 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5113
Mailing Address - Country:US
Mailing Address - Phone:512-474-0700
Mailing Address - Fax:
Practice Address - Street 1:503 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5113
Practice Address - Country:US
Practice Address - Phone:512-474-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor