Provider Demographics
NPI:1164535175
Name:DAHLKE, AMY M (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:DAHLKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:ENDRU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1027 S 17TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5761
Mailing Address - Country:US
Mailing Address - Phone:715-355-9009
Mailing Address - Fax:715-298-0841
Practice Address - Street 1:1027 S 17TH AVE STE C
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5761
Practice Address - Country:US
Practice Address - Phone:153-559-0097
Practice Address - Fax:715-298-0841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3638-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI389-23000Medicaid
WI389-23000Medicaid