Provider Demographics
NPI:1922490978
Name:KUBOSUMI, ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:KUBOSUMI
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 1:945 S BRYAN BELT LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-5080
Mailing Address - Country:US
Mailing Address - Phone:972-972-4353
Mailing Address - Fax:972-972-4352
Practice Address - Street 1:945 S BRYAN BELT LINE RD STE 200
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-5080
Practice Address - Country:US
Practice Address - Phone:972-972-4353
Practice Address - Fax:972-972-4352
Is Sole Proprietor?:No
Enumeration Date:2015-02-28
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor