Provider Demographics
NPI:1942446125
Name:PANK CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PANK CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-538-2333
Mailing Address - Street 1:36321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9186
Mailing Address - Country:US
Mailing Address - Phone:715-538-2333
Mailing Address - Fax:715-538-2429
Practice Address - Street 1:36321 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9186
Practice Address - Country:US
Practice Address - Phone:715-538-2333
Practice Address - Fax:715-538-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4149-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38963700Medicaid
WI38963700Medicaid