Provider Demographics
NPI:1154393403
Name:DIERCKS, AMY M (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:DIERCKS
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 1:3150 LONDON WAY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-9517
Mailing Address - Country:US
Mailing Address - Phone:319-210-9586
Mailing Address - Fax:
Practice Address - Street 1:214 BLAIRS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1602
Practice Address - Country:US
Practice Address - Phone:319-378-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0460469Medicaid
IA38558OtherWELLMARK INC
IA38558OtherWELLMARK INC
IA0460469Medicaid