Healthcare Provider Details

I. General information

NPI: 1740363795
Provider Name (Legal Business Name): AMY LYNNE WIESE HORTON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LYNNE WIESE D.C.

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 84TH ST
BLOOMINGTON MN
55431-1602
US

IV. Provider business mailing address

2501 W 84TH ST
BLOOMINGTON MN
55431-1602
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-4777
  • Fax: 952-886-7561
Mailing address:
  • Phone: 952-888-4777
  • Fax: 952-886-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4022
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4022
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: