Provider Demographics
NPI:1952494809
Name:ANTLE, AMY C (DC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:ANTLE
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 1:205 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2045
Mailing Address - Country:US
Mailing Address - Phone:316-215-1584
Mailing Address - Fax:
Practice Address - Street 1:1005 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4474
Practice Address - Country:US
Practice Address - Phone:316-215-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1715OtherPTAN
KS060043Medicare ID - Type Unspecified