Provider Demographics
NPI:1134678311
Name:HAEG, AMANDA JOSEPHINE (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOSEPHINE
Last Name:HAEG
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 1:6409 CITY WEST PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6409 CITY WEST PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7845
Practice Address - Country:US
Practice Address - Phone:952-212-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor