Provider Demographics
NPI:1164479580
Name:AMSTUTZ, REBECCA J (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:AMSTUTZ
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 1:15831 GOOSEBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5140
Mailing Address - Country:US
Mailing Address - Phone:612-730-6547
Mailing Address - Fax:
Practice Address - Street 1:15831 GOOSEBERRY WAY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5140
Practice Address - Country:US
Practice Address - Phone:612-730-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4757111N00000X
IN08002256A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35004136Medicare PIN
MNC03129Medicare UPIN