Provider Demographics
NPI:1033348446
Name:NASH, AMANDA MEAGAN (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MEAGAN
Last Name:NASH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 CROCKETT DR
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9052
Mailing Address - Country:US
Mailing Address - Phone:315-416-5300
Mailing Address - Fax:
Practice Address - Street 1:404 OAK ST
Practice Address - Street 2:SUITE 30
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2997
Practice Address - Country:US
Practice Address - Phone:315-425-0009
Practice Address - Fax:315-425-8881
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor