MEDICARE: AMANDA JOSEPHINE HAEG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6256	MN

General Provider Information

NPI Number	:	1134678311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JOSEPHINE HAEG D.C.

Provider Business Mailing Address
First Line	:	6409 CITY WEST PKWY
Second Line	:	SUITE 105
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6409 CITY WEST PKWY
Second Line	:	SUITE 105
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:	952-212-3770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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