Provider Demographics
NPI:1295898047
Name:AMUNDSON, DENISE A (DC)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:A
Last Name:AMUNDSON
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 1:723 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523
Mailing Address - Country:US
Mailing Address - Phone:309-274-5380
Mailing Address - Fax:309-274-8163
Practice Address - Street 1:723 N SECOND ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523
Practice Address - Country:US
Practice Address - Phone:309-274-5380
Practice Address - Fax:309-274-8163
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10671463OtherUNICARE
IL0007208710OtherBLUE CROSS BS
IL0007208710OtherBLUE CROSS BS
U67019Medicare UPIN