Provider Demographics
NPI:1508347493
Name:STONE, ANDREW KIYOSHI (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KIYOSHI
Last Name:STONE
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 1:1617 PROMONTORY TER
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1579
Mailing Address - Country:US
Mailing Address - Phone:720-530-7915
Mailing Address - Fax:
Practice Address - Street 1:1617 PROMONTORY TERRACE
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-9458
Practice Address - Country:US
Practice Address - Phone:720-530-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor