Provider Demographics
NPI:1952957433
Name:GERKE, AMANDA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:GERKE
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 1:2927 IMPRESSIONS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6700
Mailing Address - Country:US
Mailing Address - Phone:414-469-4193
Mailing Address - Fax:
Practice Address - Street 1:3927 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9700
Practice Address - Country:US
Practice Address - Phone:224-325-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor