Provider Demographics
NPI:1710252481
Name:EBERLE, AMANDA ELYSE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELYSE
Last Name:EBERLE
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 1:6506 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1037
Mailing Address - Country:US
Mailing Address - Phone:608-833-2333
Mailing Address - Fax:
Practice Address - Street 1:6506 NORMANDY LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1037
Practice Address - Country:US
Practice Address - Phone:608-833-2333
Practice Address - Fax:608-826-0996
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5253-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor