Provider Demographics
NPI:1710207014
Name:HERZER, AMANDA IRENE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:IRENE
Last Name:HERZER
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 1:1147 S WABASH AVE
Mailing Address - Street 2:250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2346
Mailing Address - Country:US
Mailing Address - Phone:312-235-0900
Mailing Address - Fax:312-235-0909
Practice Address - Street 1:1147 S WABASH AVE
Practice Address - Street 2:250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2346
Practice Address - Country:US
Practice Address - Phone:312-235-0900
Practice Address - Fax:312-235-0909
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor