Healthcare Provider Details

I. General information

NPI: 1710207014
Provider Name (Legal Business Name): AMANDA IRENE HERZER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 S WABASH AVE 250
CHICAGO IL
60605-2346
US

IV. Provider business mailing address

1147 S WABASH AVE 250
CHICAGO IL
60605-2346
US

V. Phone/Fax

Practice location:
  • Phone: 312-235-0900
  • Fax: 312-235-0909
Mailing address:
  • Phone: 312-235-0900
  • Fax: 312-235-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011708
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: