Provider Demographics
NPI:1891734984
Name:MUSE, AMANDA (DC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MUSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:804 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8976
Mailing Address - Country:US
Mailing Address - Phone:405-794-5000
Mailing Address - Fax:405-794-5003
Practice Address - Street 1:804 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8976
Practice Address - Country:US
Practice Address - Phone:405-794-5000
Practice Address - Fax:405-794-5003
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92847Medicare UPIN