Provider Demographics
NPI:1699297580
Name:BREITBACH, AMBER SUE (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:SUE
Last Name:BREITBACH
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:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-0065
Mailing Address - Country:US
Mailing Address - Phone:641-330-4018
Mailing Address - Fax:
Practice Address - Street 1:107 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-4288
Practice Address - Country:US
Practice Address - Phone:641-330-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor