Provider Demographics
NPI:1053120451
Name:PRIDEAUX, AMELIA MARIE (DC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARIE
Last Name:PRIDEAUX
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 1:3948 W 50TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1253
Mailing Address - Country:US
Mailing Address - Phone:952-920-4528
Mailing Address - Fax:
Practice Address - Street 1:3948 W 50TH ST STE 203
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1253
Practice Address - Country:US
Practice Address - Phone:952-920-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor