Healthcare Provider Details

I. General information

NPI: 1346517711
Provider Name (Legal Business Name): AMANDA MARIE STOLLE NUNIER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MISSOURI AVE STE 206D
JEFFERSONVILLE IN
47130-3084
US

IV. Provider business mailing address

590 MISSOURI AVE STE 206D
JEFFERSONVILLE IN
47130-3084
US

V. Phone/Fax

Practice location:
  • Phone: 812-913-5136
  • Fax:
Mailing address:
  • Phone: 812-913-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002613A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: