Provider Demographics
NPI:1902044878
Name:MATHIS, AMY LOUISE (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:MATHIS
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 1:516 W 35TH ST
Mailing Address - Street 2:C/O FAMILY CARE CHIROPRACTIC
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5821
Mailing Address - Country:US
Mailing Address - Phone:563-388-6364
Mailing Address - Fax:563-388-6364
Practice Address - Street 1:516 W 35TH ST
Practice Address - Street 2:C/O FAMILY CARE CHIROPRACTIC
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5821
Practice Address - Country:US
Practice Address - Phone:563-388-6364
Practice Address - Fax:563-388-6364
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor