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General NPI Number Information
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NPI Number | 1649644766
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Entity Type | Individual
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Provider Name | AMBER VANDE LINDE D.C.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 112 W BROADWAY SUITE A
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City | BOLIVAR
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State | MO
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Zip | 65613
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Country | US
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Telephone | 913-205-1108
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 S MAIN AVE APT A105
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City | SPRINGFIELD
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State | MO
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Zip | 65810-7801
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Country | US
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Telephone | 913-205-1108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01-05752
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2015033522
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License Number State | MO
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