Provider Demographics
NPI:1770886632
Name:OTEO, ANDREW ALEXANDER (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALEXANDER
Last Name:OTEO
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 1:7204 MAIN ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3430
Mailing Address - Country:US
Mailing Address - Phone:469-535-3800
Mailing Address - Fax:469-533-0399
Practice Address - Street 1:7204 MAIN ST
Practice Address - Street 2:STE. 200
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3430
Practice Address - Country:US
Practice Address - Phone:469-535-3800
Practice Address - Fax:469-533-0399
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
147413996OtherGROUP NPI
303877ZTMJOtherMEDICARE P-TAN
30495OtherMEDICARE P-TIN