Provider Demographics
NPI:1417058769
Name:AMUNDSEN, DEBORAH (DC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:AMUNDSEN
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 1:118 E RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-4527
Mailing Address - Country:US
Mailing Address - Phone:609-522-7557
Mailing Address - Fax:609-522-7557
Practice Address - Street 1:118 E RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-4527
Practice Address - Country:US
Practice Address - Phone:609-522-7557
Practice Address - Fax:609-522-7557
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00488100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU62233Medicare UPIN
NJ881886Medicare ID - Type Unspecified