Provider Demographics
NPI:1003291444
Name:BAKKE, MEREDITH HUGHES (DC)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:HUGHES
Last Name:BAKKE
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 1:4535 MEADOWWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DE FOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-1739
Mailing Address - Country:US
Mailing Address - Phone:608-577-9870
Mailing Address - Fax:
Practice Address - Street 1:312 E NORTH ST
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1258
Practice Address - Country:US
Practice Address - Phone:608-577-9870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12-1461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor