Provider Demographics
NPI:1245299890
Name:ELKINS, AMY RAE (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RAE
Last Name:ELKINS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RAE
Other - Last Name:RIETHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:108 W AUGLAIZE ST
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1534
Mailing Address - Country:US
Mailing Address - Phone:419-739-9000
Mailing Address - Fax:419-739-9005
Practice Address - Street 1:108 W AUGLAIZE ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1534
Practice Address - Country:US
Practice Address - Phone:419-739-9000
Practice Address - Fax:419-739-9005
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2381060Medicaid
OHU93154Medicare UPIN
OHEL4098003Medicare PIN