Provider Demographics
NPI:1659988848
Name:SHORTER, AMANDA (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:SHORTER
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 1:669 WINNETKA AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4576
Mailing Address - Country:US
Mailing Address - Phone:763-595-9096
Mailing Address - Fax:
Practice Address - Street 1:669 WINNETKA AVE N STE 202
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4576
Practice Address - Country:US
Practice Address - Phone:763-595-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor