Healthcare Provider Details

I. General information

NPI: 1003914821
Provider Name (Legal Business Name): DAVID BRUCE BAKKE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 EAST NORTH STREET BAKKE CHIROPRACTIC CLINIC SC
DEFOREST WI
53532
US

IV. Provider business mailing address

312 EAST NORTH STREET BAKKE CHIROPRACTIC CLINIC SC
DEFOREST WI
53532
US

V. Phone/Fax

Practice location:
  • Phone: 608-846-3333
  • Fax: 608-846-7033
Mailing address:
  • Phone: 608-846-3333
  • Fax: 608-846-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1604012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: