Provider Demographics
NPI:1629261284
Name:AUSTIN, AMANDA BEEVER (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BEEVER
Last Name:AUSTIN
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 1:520 CHEROKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3815
Mailing Address - Country:US
Mailing Address - Phone:423-265-1366
Mailing Address - Fax:423-265-1390
Practice Address - Street 1:520 CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3815
Practice Address - Country:US
Practice Address - Phone:423-265-1366
Practice Address - Fax:423-265-1390
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970240Medicare UPIN