Provider Demographics
NPI:1982055786
Name:STEWART, DEANDRA (DC)
Entity Type:Individual
Prefix:DR
First Name:DEANDRA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:DEANDRA
Other - Middle Name:
Other - Last Name:GROCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1340 US-231 #3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081
Mailing Address - Country:US
Mailing Address - Phone:334-566-5295
Mailing Address - Fax:
Practice Address - Street 1:1340 US-231 #3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081
Practice Address - Country:US
Practice Address - Phone:334-566-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1518010412OtherGROUP NPI