Provider Demographics
NPI:1821567249
Name:STEWART, AMANDA REBECCA (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REBECCA
Last Name:STEWART
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 1:636 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-5526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4058 WEBER RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3107
Practice Address - Country:US
Practice Address - Phone:361-692-2600
Practice Address - Fax:361-692-2598
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16199111N00000X
TX13945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor