Provider Demographics
NPI:1518069756
Name:GEBHARDT-FITZGERALD, AMANDA RACHEL (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHEL
Last Name:GEBHARDT-FITZGERALD
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 1:1740 WEIR DR
Mailing Address - Street 2:SUITE 24
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2282
Mailing Address - Country:US
Mailing Address - Phone:651-232-6830
Mailing Address - Fax:651-702-2636
Practice Address - Street 1:1740 WEIR DR
Practice Address - Street 2:SUITE 24
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2282
Practice Address - Country:US
Practice Address - Phone:651-232-6830
Practice Address - Fax:651-702-2636
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN313676100Medicaid
MN165P5GEOtherBCBS
V04794Medicare UPIN