Provider Demographics
NPI:1316214059
Name:PILLATZKE, NICHOLAS CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHARLES
Last Name:PILLATZKE
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 1:1024 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9120
Mailing Address - Country:US
Mailing Address - Phone:605-882-3726
Mailing Address - Fax:605-882-3727
Practice Address - Street 1:1024 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9120
Practice Address - Country:US
Practice Address - Phone:605-882-3726
Practice Address - Fax:605-882-3727
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS106536Medicare PIN