Provider Demographics
NPI:1821160698
Name:BORRE, AMANDA BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BETH
Last Name:BORRE
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 1:3015 E NEW YORK ST
Mailing Address - Street 2:SUITE A11
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5162
Mailing Address - Country:US
Mailing Address - Phone:630-820-1330
Mailing Address - Fax:630-820-1554
Practice Address - Street 1:3015 E NEW YORK ST
Practice Address - Street 2:SUITE A11
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5162
Practice Address - Country:US
Practice Address - Phone:630-820-1330
Practice Address - Fax:630-820-1554
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7282480OtherDR BORRE ID-AETNA
IL996513OtherGALAXY
IL02232251OtherBLUE CROSS BLUE SHIELD
IL2122346216301OtherBEECH STREET
IL6937OtherUNITED HEALTH SERVICE
IL038009855Medicaid
IL661636OtherAMERICAN CHIROPRACTIC NET
IL7466464OtherCLINIC ID-AETNA
IL660636OtherUNITED HEALTH CARE
IL204729Medicare ID - Type Unspecified
IL038009855Medicaid