Provider Demographics
NPI:1295728145
Name:GUNDERSON-MCNEIL, AMY LOUISE (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:GUNDERSON-MCNEIL
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 1:3229 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-6151
Mailing Address - Country:US
Mailing Address - Phone:123-065-5506
Mailing Address - Fax:
Practice Address - Street 1:3229 90TH AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-6151
Practice Address - Country:US
Practice Address - Phone:612-306-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU95294Medicare UPIN
MN350002881Medicare ID - Type Unspecified