MEDICARE: DR. AUDREY A VANDEWALLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11404	TX

General Provider Information

NPI Number	:	1831412014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY A VANDEWALLE D.C.

Provider Business Mailing Address
First Line	:	3007 DAWN DR
Second Line	:	STE 101
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2864
Country	:	US
Telephone Number	:	512-863-7000
Fax Number	:	512-231-1087

Provider Business Practice Location Address
First Line	:	4210 SPICEWOOD SPRINGS RD STE 205
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8654
Country	:	US
Telephone Number	:	512-863-7000
Fax Number	:	512-863-0066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	07/12/2023

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