Provider Demographics
NPI:1801374855
Name:BLONIGEN, AMANDA DANIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DANIELLE
Last Name:BLONIGEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DANIELLE
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2029 COUNTY HIGHWAY I STE 3
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-4420
Mailing Address - Country:US
Mailing Address - Phone:715-720-8500
Mailing Address - Fax:715-720-8507
Practice Address - Street 1:2029 COUNTY HIGHWAY I STE 3
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-4420
Practice Address - Country:US
Practice Address - Phone:715-720-8500
Practice Address - Fax:715-720-8507
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5375-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor