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General NPI Number Information
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NPI Number | 1851473359
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Entity Type | Individual
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Provider Name | AMY SUSANNE HIETALA DC
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Gender | Female
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 215 N 2ND ST 201
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City | RIVER FALLS
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State | WI
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Zip | 54022-3706
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Country | US
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Telephone | 715-425-6665
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Fax | 715-425-6677
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Provider Business Mailing Address
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Address Line | 1419 FRANKLIN ST
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City | BALDWIN
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State | WI
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Zip | 54002-9319
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Country | US
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Telephone | 920-889-0007
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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 | 3470
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License Number State | WI
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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 | MN3382
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License Number State | MN
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