Provider Demographics
NPI:1740360023
Name:COLLIER, AMANDA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNN
Last Name:COLLIER
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 1:51 STREET OF DREAMS
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1134
Mailing Address - Country:US
Mailing Address - Phone:304-263-4927
Mailing Address - Fax:304-263-0682
Practice Address - Street 1:51 STREET OF DREAMS
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1134
Practice Address - Country:US
Practice Address - Phone:304-263-4927
Practice Address - Fax:304-263-0682
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005545Medicaid
WV693791OtherACN #
WV693791OtherACN #
WVC04159031Medicare PIN