MEDICARE: DR. AMANDA DANIELLE BLONIGEN 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	111N00000X	Chiropractor	5375-12	WI

General Provider Information

NPI Number	:	1801374855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA DANIELLE BLONIGEN DC

Provider Business Mailing Address
First Line	:	2029 COUNTY HIGHWAY I STE 3
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-4420
Country	:	US
Telephone Number	:	715-720-8500
Fax Number	:	715-720-8507

Provider Business Practice Location Address
First Line	:	2029 COUNTY HIGHWAY I STE 3
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-4420
Country	:	US
Telephone Number	:	715-720-8500
Fax Number	:	715-720-8507

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	12/10/2021

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