Provider Demographics
NPI:1083714679
Name:BAKKEN, ANDREW GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GARY
Last Name:BAKKEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 2ND ST N STE 220
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2001
Mailing Address - Country:US
Mailing Address - Phone:608-782-7738
Mailing Address - Fax:
Practice Address - Street 1:300 2ND ST N STE 220
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2001
Practice Address - Country:US
Practice Address - Phone:608-782-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU87395Medicare UPIN