Provider Demographics
NPI:1437238631
Name:PROKOP, AMANDA JOY (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOY
Last Name:PROKOP
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 1:1205 NORTH DIXIE FREEWAY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:386-423-5259
Mailing Address - Fax:386-423-0929
Practice Address - Street 1:1205 NORTH DIXIE FREEWAY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168
Practice Address - Country:US
Practice Address - Phone:386-423-5259
Practice Address - Fax:386-423-0929
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor