Provider Demographics
NPI:1578669016
Name:HESSEL, AMANDA MARIE (OTR, DC, LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HESSEL
Suffix:
Gender:F
Credentials:OTR, DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 WALNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5745
Mailing Address - Country:US
Mailing Address - Phone:303-587-9437
Mailing Address - Fax:303-587-9437
Practice Address - Street 1:2503 WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5745
Practice Address - Country:US
Practice Address - Phone:303-587-9437
Practice Address - Fax:303-587-9437
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4189225XH1200X
171100000X
CO7235111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000179343OtherANTHEM HEALTH PLAN
IN000000375790Medicaid
IN000000375790Medicaid