Provider Demographics
NPI:1184795403
Name:ABBOTT, AMY KAHN (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:KAHN
Last Name:ABBOTT
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 1:1627 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-9426
Mailing Address - Country:US
Mailing Address - Phone:616-359-9077
Mailing Address - Fax:
Practice Address - Street 1:1627 142ND AVE
Practice Address - Street 2:
Practice Address - City:DORR
Practice Address - State:MI
Practice Address - Zip Code:49323-9426
Practice Address - Country:US
Practice Address - Phone:616-359-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor