Provider Demographics
NPI:1922124759
Name:BOVENKAMP, AMY G (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:G
Last Name:BOVENKAMP
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:PO BOX 47088
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7088
Mailing Address - Country:US
Mailing Address - Phone:206-937-3965
Mailing Address - Fax:206-937-4695
Practice Address - Street 1:3703 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3771
Practice Address - Country:US
Practice Address - Phone:206-937-3965
Practice Address - Fax:206-937-4695
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB01129Medicare ID - Type Unspecified