Provider Demographics
NPI:1194805945
Name:SANDOVAL, ANDY LORENZO (DC)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:LORENZO
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4251 E MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-8639
Mailing Address - Country:US
Mailing Address - Phone:505-325-3355
Mailing Address - Fax:505-325-4479
Practice Address - Street 1:4251 E MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8639
Practice Address - Country:US
Practice Address - Phone:505-325-3355
Practice Address - Fax:505-325-4479
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM1235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor