Provider Demographics
NPI:1205836756
Name:PISCHKE, CYNTHIA LS (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LS
Last Name:PISCHKE
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 1:2 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-2578
Mailing Address - Country:US
Mailing Address - Phone:515-332-1504
Mailing Address - Fax:515-332-4660
Practice Address - Street 1:2 3RD ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-2578
Practice Address - Country:US
Practice Address - Phone:515-332-1504
Practice Address - Fax:515-332-4660
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
IAA06191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185512Medicaid
IA47705OtherWELLMARK BCBS
U74132Medicare UPIN
IA0185512Medicaid