Provider Demographics
NPI:1275085045
Name:DEYAERT, AMANDA LYNN (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:DEYAERT
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 1:45070 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:CHASSELL
Mailing Address - State:MI
Mailing Address - Zip Code:49916-9168
Mailing Address - Country:US
Mailing Address - Phone:906-482-2400
Mailing Address - Fax:
Practice Address - Street 1:45070 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:CHASSELL
Practice Address - State:MI
Practice Address - Zip Code:49916-9168
Practice Address - Country:US
Practice Address - Phone:906-482-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor