Provider Demographics
NPI:1871777474
Name:FRIEMEL PANEK, AMANDA DIANE (DC,FIAMA,DIPLAC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DIANE
Last Name:FRIEMEL PANEK
Suffix:
Gender:F
Credentials:DC,FIAMA,DIPLAC
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:DIANE
Other - Last Name:FRIEMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:24609 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:52767
Mailing Address - Country:US
Mailing Address - Phone:563-888-1978
Mailing Address - Fax:
Practice Address - Street 1:24609 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:IA
Practice Address - Zip Code:52767
Practice Address - Country:US
Practice Address - Phone:563-888-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010735111N00000X
IA06633111N00000X
KY4818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0201796Medicaid
IA1871777474OtherINDIVIDUAL NPI
IA1477566404OtherGROUP NPI
IA72004OtherWELLMARK
IAI11500OtherMEDICARE GROUP