Healthcare Provider Details

I. General information

NPI: 1104156140
Provider Name (Legal Business Name): ERIN ELIZABETH NASH D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN ELIZABETH JUCKEM D.C.

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 SILVERNAIL RD
PEWAUKEE WI
53072-5402
US

IV. Provider business mailing address

2343 SILVERNAIL RD
PEWAUKEE WI
53072-5402
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-9000
  • Fax: 262-548-8155
Mailing address:
  • Phone: 262-548-9000
  • Fax: 262-548-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4557012
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: