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General NPI Number Information
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NPI Number | 1942446125
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Entity Type | Organization
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Legal Business Name | PANK CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 36321 MAIN ST
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City | WHITEHALL
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State | WI
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Zip | 54773-9186
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Country | US
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Telephone | 715-538-2333
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Fax | 715-538-2429
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Provider Business Mailing Address
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Address Line | 36321 MAIN ST
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City | WHITEHALL
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State | WI
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Zip | 54773-9186
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Country | US
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Telephone | 715-538-2333
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Fax | 715-538-2429
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Authorized Official
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Title or Position | OWNER
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Name | SARA PANK
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Credential | DC
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Telephone | 715-538-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4149-012
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License Number State | WI
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