Provider Demographics
NPI:1003921073
Name:FOERSTER, AMY L (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:FOERSTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:GLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:23521 82ND PL
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9037
Mailing Address - Country:US
Mailing Address - Phone:262-909-1039
Mailing Address - Fax:262-843-8218
Practice Address - Street 1:11300 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7308
Practice Address - Country:US
Practice Address - Phone:262-909-1039
Practice Address - Fax:262-843-8218
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3968-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor