Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4961-12 | WI |
NPI | 1003156985 |
---|---|
Provider Name | Amanda Lynn Whitledge |
First Address | Sturtevant, WI 53177-1827 |
Second Address | Sturtevant, WI 53177-1827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2013 |
Last Update Date | 04/02/2022 |