MEDICARE: ANDREW RAPHAEL SANDOVAL DC

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	111NR0400X	Rehabilitation Chiropractor	15748	TX

General Provider Information

NPI Number	:	1942062450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW RAPHAEL SANDOVAL DC

Provider Business Mailing Address
First Line	:	575 COMMERCIAL ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4211
Country	:	US
Telephone Number	:	830-776-1289
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 COMMERCIAL ST
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4211
Country	:	US
Telephone Number	:	830-776-1289
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	09/29/2025

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