Provider Demographics
NPI:1073553236
Name:AMY, JOHN ROGER (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROGER
Last Name:AMY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1776
Mailing Address - Country:US
Mailing Address - Phone:814-734-7784
Mailing Address - Fax:
Practice Address - Street 1:12650 EDINBORO RD
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2263
Practice Address - Country:US
Practice Address - Phone:814-734-4541
Practice Address - Fax:814-734-5562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007922L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84298Medicare UPIN