Provider Demographics
NPI:1669588711
Name:PRITCHARD, AMBERLEE NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:AMBERLEE
Middle Name:NICOLE
Last Name:PRITCHARD
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 1:10513 LINCOLN TRAIL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208
Mailing Address - Country:US
Mailing Address - Phone:618-398-7550
Mailing Address - Fax:618-398-7553
Practice Address - Street 1:10513 LINCOLN TRAIL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208
Practice Address - Country:US
Practice Address - Phone:618-398-7550
Practice Address - Fax:618-398-7553
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8282018OtherBCBS
213540Medicare ID - Type Unspecified