Provider Demographics
NPI:1285264143
Name:AVERY, AMBER JADE (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:JADE
Last Name:AVERY
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 1:13613 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4133
Mailing Address - Country:US
Mailing Address - Phone:952-237-9699
Mailing Address - Fax:
Practice Address - Street 1:12400 PILLSBURY AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3835
Practice Address - Country:US
Practice Address - Phone:952-890-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor