Provider Demographics
NPI:1003156985
Name:WHITLEDGE, AMANDA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:WHITLEDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:NENNEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2753 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-1827
Mailing Address - Country:US
Mailing Address - Phone:262-886-8600
Mailing Address - Fax:262-886-5342
Practice Address - Street 1:2753 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1827
Practice Address - Country:US
Practice Address - Phone:262-886-8600
Practice Address - Fax:262-886-5342
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI4961-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program