Provider Demographics
NPI:1427044429
Name:AMOTH, TAMMY ONETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:ONETTE
Last Name:AMOTH
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 1:534 WATER ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5631
Mailing Address - Country:US
Mailing Address - Phone:715-838-9432
Mailing Address - Fax:715-838-9435
Practice Address - Street 1:534 WATER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5631
Practice Address - Country:US
Practice Address - Phone:715-838-9432
Practice Address - Fax:715-838-9435
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3867-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU95696Medicare UPIN