Provider Demographics
NPI:1952455750
Name:FOSS, AMY M (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:FOSS
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 1:1021 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2207
Mailing Address - Country:US
Mailing Address - Phone:406-293-8736
Mailing Address - Fax:406-293-8737
Practice Address - Street 1:1021 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2207
Practice Address - Country:US
Practice Address - Phone:406-293-8736
Practice Address - Fax:406-293-8737
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0203511111N00000X
MT1165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7310F0OtherASURIS PROVIDER ID
WAP00284508OtherRAILROAD MEDICARE
WA000010154052OtherREGENCE OF ID PROV #
WA0203511OtherLABOR & INDUSTRIES ID #
98225OtherAWHN PROVIDER ID
98225OtherAWHN PROVIDER ID
V0770Medicare UPIN