| NPI | 1740363795 |
|---|---|
| Former Name | AMY LYNNE WIESE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MN 4022) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: MN 4022) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |