Provider Demographics
NPI:1831412014
Name:VANDEWALLE, AUDREY A (DC)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:A
Last Name:VANDEWALLE
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 1:3007 DAWN DR
Mailing Address - Street 2:STE 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2864
Mailing Address - Country:US
Mailing Address - Phone:512-863-7000
Mailing Address - Fax:512-231-1087
Practice Address - Street 1:4210 SPICEWOOD SPRINGS RD STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8654
Practice Address - Country:US
Practice Address - Phone:512-863-7000
Practice Address - Fax:512-863-0066
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor