Provider Demographics
NPI:1831350420
Name:ANDREWS, STEPHEN WADE (LAC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WADE
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4513
Mailing Address - Country:US
Mailing Address - Phone:512-468-0899
Mailing Address - Fax:
Practice Address - Street 1:2000 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1132
Practice Address - Country:US
Practice Address - Phone:512-468-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00756171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist