Provider Demographics
NPI:1811432768
Name:ETUK, ANDREW JOHNSON (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHNSON
Last Name:ETUK
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 1:8330 LBJ FWY STE 255
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1206
Mailing Address - Country:US
Mailing Address - Phone:972-804-6105
Mailing Address - Fax:
Practice Address - Street 1:8330 LBJ FWY STE 255
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1206
Practice Address - Country:US
Practice Address - Phone:972-804-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40510214111NS0005X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician