Provider Demographics
NPI:1437181427
Name:LIGHT, ANDREW WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAYNE
Last Name:LIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:22611 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-4943
Mailing Address - Country:US
Mailing Address - Phone:281-354-2115
Mailing Address - Fax:281-354-2116
Practice Address - Street 1:22611 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-4943
Practice Address - Country:US
Practice Address - Phone:281-354-2115
Practice Address - Fax:281-354-2116
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBPB133OtherBCBS
TX609986Medicare ID - Type Unspecified
U97179Medicare UPIN