Provider Demographics
NPI:1942062450
Name:SANDOVAL, ANDREW RAPHAEL (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RAPHAEL
Last Name:SANDOVAL
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 1:954 VISTA HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4149
Mailing Address - Country:US
Mailing Address - Phone:830-776-1289
Mailing Address - Fax:
Practice Address - Street 1:1838 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4713
Practice Address - Country:US
Practice Address - Phone:830-776-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty