Amanda M Hetzel, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5477-12 Issued in WI

Practice address

505 Lake St
Green Lake, WI 54941-8820

Phone

(920) 294-3130

Fax

(920) 294-3238

NPI assigned

Sep 9, 2019

Last updated

Aug 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amanda M Oberc Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chiroplus Complementary Healthcare Centers, LLC

  • Chiropractor
  • Wautoma, WI
  • NPI 1285773820
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661644800000",
    "number": "1013566421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549410458",
            "telephone_number": "920-294-3130",
            "fax_number": "920-294-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 LAKE ST",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418820",
            "telephone_number": "920-294-3130",
            "fax_number": "920-294-3238"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "W7841 State Road 21 73",
            "address_purpose": "LOCATION",
            "city": "Wautoma",
            "state": "WI",
            "postal_code": "549825219",
            "country_code": "US",
            "telephone_number": "920-787-0081",
            "fax_number": "920-787-0083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HETZEL",
        "first_name": "AMANDA",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-09",
        "last_updated": "2022-08-28",
        "certification_date": "2022-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5477-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "portal.chiroplushealthcare.com",
            "affiliation": "N",
            "endpointDescription": "secure patient portal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "505 Lake St",
            "city": "Green Lake",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549418820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "OBERC",
            "middle_name": "M",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Chiropractor in Green Lake, WI
• Providers in Green Lake, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.