Provider Demographics
NPI:1669678603
Name:STUBER, AMY (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:STUBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:153 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2357
Mailing Address - Country:US
Mailing Address - Phone:715-201-1081
Mailing Address - Fax:715-350-6767
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2357
Practice Address - Country:US
Practice Address - Phone:715-201-1081
Practice Address - Fax:715-350-6767
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4322-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor