Provider Demographics
NPI:1285401059
Name:MA, AMANDA (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MA
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 1:10822 SE 82ND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7658
Mailing Address - Country:US
Mailing Address - Phone:503-308-8484
Mailing Address - Fax:
Practice Address - Street 1:10822 SE 82ND AVE STE B
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7658
Practice Address - Country:US
Practice Address - Phone:503-308-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor