MEDICARE: DR. AMANDA IRENE HERZER 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	038011708	IL

General Provider Information

NPI Number	:	1710207014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA IRENE HERZER D.C.

Provider Business Mailing Address
First Line	:	1147 S WABASH AVE
Second Line	:	250
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-235-0900
Fax Number	:	312-235-0909

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE
Second Line	:	250
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-235-0900
Fax Number	:	312-235-0909

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	06/09/2010

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