Provider Demographics
NPI:1801135850
Name:BAKKEN PASCHKE, JESSICA ANN (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:BAKKEN PASCHKE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:BAKKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:505 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4414
Mailing Address - Country:US
Mailing Address - Phone:701-672-8100
Mailing Address - Fax:701-672-8101
Practice Address - Street 1:505 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4414
Practice Address - Country:US
Practice Address - Phone:701-672-8100
Practice Address - Fax:701-672-8101
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor