Provider Demographics
NPI:1164939369
Name:PAMELA L TICKEL DC INC.
Entity Type:Organization
Organization Name:PAMELA L TICKEL DC INC.
Other - Org Name:TICKEL CHIROPRACTIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-965-1851
Mailing Address - Street 1:400 N WELLS ST STE 340
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-2761
Mailing Address - Country:US
Mailing Address - Phone:513-965-1851
Mailing Address - Fax:
Practice Address - Street 1:400 N WELLS ST STE 340
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-2761
Practice Address - Country:US
Practice Address - Phone:513-965-1851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
IL038.003947261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1902903255OtherNPI