Provider Demographics
NPI:1790863371
Name:AMUNDGAARD, MATTHEW JOHN (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:AMUNDGAARD
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 YORK AVE S APT 802
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4443
Mailing Address - Country:US
Mailing Address - Phone:612-702-7367
Mailing Address - Fax:
Practice Address - Street 1:1146 EAST COUNTY ROAD E
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-486-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor