Provider Demographics
NPI:1487014619
Name:KLOSTERMAN, AMANDA (DC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KLOSTERMAN
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 1:2172 BLACKBERRY DR
Mailing Address - Street 2:STE 102
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1103
Mailing Address - Country:US
Mailing Address - Phone:630-332-0471
Mailing Address - Fax:630-402-3813
Practice Address - Street 1:2172 BLACKBERRY DR
Practice Address - Street 2:STE 102
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1103
Practice Address - Country:US
Practice Address - Phone:630-332-0471
Practice Address - Fax:630-402-3813
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor