Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12-1461 | WI |
NPI | 1003291444 |
---|---|
Provider Name | Dr. Meredith Hughes Bakke |
First Address | De Forest, WI 53532-1739 |
Second Address | De Forest, WI 53532-1258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2015 |
Last Update Date | 28/07/2015 |