Healthcare Provider Details

I. General information

NPI: 1164939369
Provider Name (Legal Business Name): PAMELA L TICKEL DC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WELLS ST STE 340
CHICAGO IL
60654-2761
US

IV. Provider business mailing address

400 N WELLS ST STE 340
CHICAGO IL
60654-2761
US

V. Phone/Fax

Practice location:
  • Phone: 513-965-1851
  • Fax:
Mailing address:
  • Phone: 513-965-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number038.003947
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PAMELA LOUISE TICKEL
Title or Position: OWNER / PROVIDER
Credential: DC
Phone: 513-965-1851