Provider Demographics
NPI:1386045805
Name:HUSTON, ANDREW WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WAYNE
Last Name:HUSTON
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 1:2704 DELTA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1740
Mailing Address - Country:US
Mailing Address - Phone:541-484-0360
Mailing Address - Fax:541-484-9036
Practice Address - Street 1:2704 DELTA OAKS DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1740
Practice Address - Country:US
Practice Address - Phone:541-484-0360
Practice Address - Fax:541-484-9036
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13598503OtherCAQH ID