Provider Demographics
NPI:1477027183
Name:GATES, AMY (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:GATES
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 1:562 HARMON LOOP RD STE NO129
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6538
Mailing Address - Country:US
Mailing Address - Phone:671-637-8901
Mailing Address - Fax:671-637-8906
Practice Address - Street 1:562 HARMON LOOP RD STE NO129
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6538
Practice Address - Country:US
Practice Address - Phone:671-637-8901
Practice Address - Fax:671-637-8906
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUC-43111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU1841489986OtherCHIROPRACTIC