Provider Demographics
NPI:1821163098
Name:AMDAHL, TROY A (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:A
Last Name:AMDAHL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1733
Mailing Address - Country:US
Mailing Address - Phone:507-285-1677
Mailing Address - Fax:507-285-0052
Practice Address - Street 1:1204 7TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1733
Practice Address - Country:US
Practice Address - Phone:507-285-1677
Practice Address - Fax:507-285-0052
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU39137Medicare UPIN