Provider Demographics
NPI:1679667893
Name:BLEVINS, AMY L (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BLEVINS
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 1:1912 MIDDLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7600
Mailing Address - Country:US
Mailing Address - Phone:563-888-5130
Mailing Address - Fax:563-888-1780
Practice Address - Street 1:1912 MIDDLE RD STE 200
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7600
Practice Address - Country:US
Practice Address - Phone:563-888-5130
Practice Address - Fax:563-888-1780
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002063A111N00000X
IA06561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33136OtherWELLMARK BC/BS
239564OtherPPO
239564OtherPPO
I15186Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER