Provider Demographics
NPI:1235769761
Name:FOREMAN, AMELIA N (DC)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:N
Last Name:FOREMAN
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 1:2829 HIGH RIDGE BLVD UNIT 936
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-4035
Mailing Address - Country:US
Mailing Address - Phone:314-325-4904
Mailing Address - Fax:
Practice Address - Street 1:2412 COZY LN
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2475
Practice Address - Country:US
Practice Address - Phone:765-269-6927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019016345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor