Provider Demographics
NPI:1780051706
Name:KLEIN, AMY LYNN (DC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1472
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-1472
Mailing Address - Country:US
Mailing Address - Phone:701-842-4300
Mailing Address - Fax:
Practice Address - Street 1:710 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7353
Practice Address - Country:US
Practice Address - Phone:701-842-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1077111N00000X
MN6254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor