Provider Demographics
NPI:1578082756
Name:HEWETT, AUDRA VIRGINA (DC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:VIRGINA
Last Name:HEWETT
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 1:8390 CHAMPIONS GATE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8313
Mailing Address - Country:US
Mailing Address - Phone:407-885-9229
Mailing Address - Fax:407-386-6338
Practice Address - Street 1:8390 CHAMPIONS GATE BLVD STE 315
Practice Address - Street 2:
Practice Address - City:CHAMPIONS GATE
Practice Address - State:FL
Practice Address - Zip Code:33896-8313
Practice Address - Country:US
Practice Address - Phone:407-885-9229
Practice Address - Fax:407-386-6338
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2023-10-03
Deactivation Date:2018-06-15
Deactivation Code:
Reactivation Date:2018-07-10
Provider Licenses
StateLicense IDTaxonomies
FLCH12241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor