Provider Demographics
NPI:1912926098
Name:HUYCK, ANDY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:WILLIAM
Last Name:HUYCK
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:PO BOX 1953
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-1953
Mailing Address - Country:US
Mailing Address - Phone:805-466-0807
Mailing Address - Fax:
Practice Address - Street 1:8548 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5366
Practice Address - Country:US
Practice Address - Phone:805-466-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17365111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17365Medicare ID - Type Unspecified