Provider Demographics
NPI:1922185180
Name:FLIKKE, STEPHEN GARY (DC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GARY
Last Name:FLIKKE
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 1:2501 HANLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8705
Mailing Address - Country:US
Mailing Address - Phone:715-386-4075
Mailing Address - Fax:715-386-4069
Practice Address - Street 1:2501 HANLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8705
Practice Address - Country:US
Practice Address - Phone:715-386-4075
Practice Address - Fax:715-386-4069
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1700031044OtherCLINIC NPI
MN254K950OtherBLUE CROSS BLUE SHIELD
WI1922185180Medicaid
WI1922185180Medicaid