Provider Demographics
NPI:1154359677
Name:MESSER, AMANDA L (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:L
Last Name:MESSER
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 1:1050 E INTERSTATE AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0550
Mailing Address - Country:US
Mailing Address - Phone:701-255-6377
Mailing Address - Fax:701-255-2638
Practice Address - Street 1:1050 E INTERSTATE AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0550
Practice Address - Country:US
Practice Address - Phone:701-255-6377
Practice Address - Fax:701-255-2638
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13654Medicaid
NDU84899Medicare UPIN
NDN711802Medicare PIN