Provider Demographics
NPI:1073146650
Name:MATHWIG, AMANDA M (DC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:MATHWIG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:721 CARDINAL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3216
Mailing Address - Country:US
Mailing Address - Phone:920-434-2221
Mailing Address - Fax:920-434-2483
Practice Address - Street 1:721 CARDINAL LN STE 100
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-3216
Practice Address - Country:US
Practice Address - Phone:920-434-2221
Practice Address - Fax:920-434-2483
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5496-12111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation