Healthcare Provider Details

I. General information

NPI: 1821160698
Provider Name (Legal Business Name): AMANDA BETH BORRE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 E NEW YORK ST SUITE A11
AURORA IL
60504-5162
US

IV. Provider business mailing address

3015 E NEW YORK ST SUITE A11
AURORA IL
60504-5162
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-1330
  • Fax: 630-820-1554
Mailing address:
  • Phone: 630-820-1330
  • Fax: 630-820-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: