Provider Demographics
NPI:1427104298
Name:HOOGESTEGER, AMANDA S (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:HOOGESTEGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:S
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-0274
Mailing Address - Country:US
Mailing Address - Phone:715-884-2379
Mailing Address - Fax:715-884-2411
Practice Address - Street 1:8243 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9527
Practice Address - Country:US
Practice Address - Phone:715-884-2379
Practice Address - Fax:715-884-2411
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4283-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38974200Medicaid
WI38974200Medicaid
WI000170108Medicare PIN