Provider Demographics
NPI:1538287545
Name:OWENS, AMANDA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:OWENS
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 1:3700 I 70 DR SE
Mailing Address - Street 2:STE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6587
Mailing Address - Country:US
Mailing Address - Phone:573-268-1704
Mailing Address - Fax:
Practice Address - Street 1:3600 INTERSTATE 70 DR SE
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6583
Practice Address - Country:US
Practice Address - Phone:573-268-1704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20-5934081OtherEIN