Healthcare Provider Details

I. General information

NPI: 1417058769
Provider Name (Legal Business Name): DEBORAH AMUNDSEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E RIO GRANDE AVE
WILDWOOD NJ
08260-4527
US

IV. Provider business mailing address

118 E RIO GRANDE AVE
WILDWOOD NJ
08260-4527
US

V. Phone/Fax

Practice location:
  • Phone: 609-522-7557
  • Fax: 609-522-7557
Mailing address:
  • Phone: 609-522-7557
  • Fax: 609-522-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00488100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: