Provider Demographics
NPI:1649644766
Name:VANDE LINDE, AMBER (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:VANDE LINDE
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 1:5100 S MAIN AVE APT A105
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-7801
Mailing Address - Country:US
Mailing Address - Phone:913-205-1108
Mailing Address - Fax:
Practice Address - Street 1:112 W BROADWAY SUITE A
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:913-205-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05752111N00000X
MO2015033522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor