Provider Demographics
NPI:1790138022
Name:MAGSUMBOL, ANDREW EDMUND (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:EDMUND
Last Name:MAGSUMBOL
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 1:205 E 3RD AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4050
Mailing Address - Country:US
Mailing Address - Phone:650-242-1695
Mailing Address - Fax:
Practice Address - Street 1:205 E 3RD AVE STE 412
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4050
Practice Address - Country:US
Practice Address - Phone:650-242-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor