Provider Demographics
NPI:1245614882
Name:AMPONSAH, MAAME (DC)
Entity type:Individual
Prefix:
First Name:MAAME
Middle Name:
Last Name:AMPONSAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1000 BURR RIDGE PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0845
Mailing Address - Country:US
Mailing Address - Phone:630-920-4670
Mailing Address - Fax:630-920-4687
Practice Address - Street 1:3900 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805
Practice Address - Country:US
Practice Address - Phone:630-920-4670
Practice Address - Fax:630-920-4687
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
IL038012840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist