Provider Demographics
NPI:1801972898
Name:NISSEN, GAYLE ANN (DC)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:ANN
Last Name:NISSEN
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:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-0668
Mailing Address - Country:US
Mailing Address - Phone:715-273-5290
Mailing Address - Fax:
Practice Address - Street 1:187 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011
Practice Address - Country:US
Practice Address - Phone:715-273-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN64363NIOtherBLUECROSS BLUE SHIELD OF MN
WI392040911010OtherBCBS
MN411508205OtherHEALTH SERVICES MGMT