Provider Demographics
NPI:1518107408
Name:SMICKLAS, AMANDA RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RENEE
Last Name:SMICKLAS
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 1:8508 N SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4846
Mailing Address - Country:US
Mailing Address - Phone:520-867-2122
Mailing Address - Fax:
Practice Address - Street 1:6814 N ORACLE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4248
Practice Address - Country:US
Practice Address - Phone:520-867-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor