Healthcare Provider Details

I. General information

NPI: 1114287877
Provider Name (Legal Business Name): AMY R HERSHBERGER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N ELIDA ST SUITE 2
WINNEBAGO IL
61088
US

IV. Provider business mailing address

506 N ELIDA ST PO BOX 383
WINNEBAGO IL
61088
US

V. Phone/Fax

Practice location:
  • Phone: 815-541-7719
  • Fax:
Mailing address:
  • Phone: 815-335-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: