Provider Demographics
NPI:1962964817
Name:LUTZOW, AMANDA (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:LUTZOW
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 1:5820 MARKET WAY DR APT 2407
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4933
Mailing Address - Country:US
Mailing Address - Phone:847-867-4402
Mailing Address - Fax:
Practice Address - Street 1:17228 LANCASTER HWY STE 208
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2048
Practice Address - Country:US
Practice Address - Phone:704-271-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor