Provider Demographics
NPI:1982758579
Name:PEZO, AMY A (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:A
Last Name:PEZO
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 EUCLID AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2048
Mailing Address - Country:US
Mailing Address - Phone:406-442-3642
Mailing Address - Fax:
Practice Address - Street 1:1617 EUCLID AVE STE 5
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2048
Practice Address - Country:US
Practice Address - Phone:406-442-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT544111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4191Medicare ID - Type Unspecified