Provider Demographics
NPI:1275051641
Name:SCIPHO, AMANDA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:SCIPHO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:LOVEKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3938 JANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1912
Mailing Address - Country:US
Mailing Address - Phone:314-369-9199
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3035
Practice Address - Country:US
Practice Address - Phone:314-329-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018017941111N00000X
OHDC-04756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311584874OtherCORPORATE TAX ID NUMBER