Provider Demographics
NPI:1366105926
Name:GOTTMAN, AMANDA ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:GOTTMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:GIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-1649
Mailing Address - Country:US
Mailing Address - Phone:573-769-2400
Mailing Address - Fax:
Practice Address - Street 1:219 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:MO
Practice Address - Zip Code:63461-1649
Practice Address - Country:US
Practice Address - Phone:573-769-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021042434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor