Provider Demographics
NPI:1689808362
Name:HOLZER, AMY MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:HOLZER
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 1:5005 RIVIERA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5805
Mailing Address - Country:US
Mailing Address - Phone:260-471-4090
Mailing Address - Fax:260-471-9919
Practice Address - Street 1:5005 RIVIERA CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-5805
Practice Address - Country:US
Practice Address - Phone:260-471-4090
Practice Address - Fax:260-471-9919
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002465A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor