Provider Demographics
NPI:1508948266
Name:TWITCHELL, ANDREW C SR (DC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:C
Last Name:TWITCHELL
Suffix:SR
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 1:710 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5808
Mailing Address - Country:US
Mailing Address - Phone:505-887-3263
Mailing Address - Fax:505-887-6296
Practice Address - Street 1:710 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5808
Practice Address - Country:US
Practice Address - Phone:505-887-3263
Practice Address - Fax:505-887-6296
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA2866Medicaid
NM300521035OtherMEDICARE PTAN
NM1831390939OtherMEDICARE NPI
NM300521035OtherMEDICARE PTAN
NM343412800Medicare ID - Type Unspecified