Provider Demographics
NPI:1518685783
Name:SCHWAB, ANDREA (DC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SCHWAB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 S HIGHLAND AVE APT B201
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3562
Mailing Address - Country:US
Mailing Address - Phone:760-272-0305
Mailing Address - Fax:
Practice Address - Street 1:1783 FLIGHT WAY
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1838
Practice Address - Country:US
Practice Address - Phone:949-449-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor