Provider Demographics
NPI:1821511841
Name:VANDEN AVOND, AMBER BETH (DC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:BETH
Last Name:VANDEN AVOND
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 1:305 STEELE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ALGOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54201-1266
Mailing Address - Country:US
Mailing Address - Phone:920-316-0656
Mailing Address - Fax:
Practice Address - Street 1:305 STEELE ST STE 1
Practice Address - Street 2:
Practice Address - City:ALGOMA
Practice Address - State:WI
Practice Address - Zip Code:54201-1266
Practice Address - Country:US
Practice Address - Phone:920-316-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5296-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor