Individual provider Active NPI

Andrew Gary Bakken, D.C.

  • Chiropractor
  • La Crosse, WI
National Provider Identifier
1083714679
Registry record updated Jan 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3804 Issued in WI
Practice address
300 2ND St N Ste 220
La Crosse, WI 54601-2001
Phone
(608) 782-7738
NPI assigned
Sep 23, 2006
Last updated
Jan 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3804 WI Primary

Addresses

Primary practice location

300 2ND St N Ste 220
La Crosse, WI 54601-2001

Mailing address

300 2ND St N Ste 220
La Crosse, WI 54601-2001
Phone (608) 782-7738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051213000377 WI Practitioner - Chiropractic 6901827575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

300 2ND St N
Suite 220
La Crosse, WI 54601-2001
Phone (608) 782-7738

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3804WIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Back-in-Action Chiropractic Chiropractor CurrentSince Nov 1, 2012 Accepting new patients
Racine Family Care Chiropractic, LLC Chiropractor PastSince Jan 1, 2012 Accepting new patients

Locations

300 2nd St N
Ste 220
La Crosse, WI 54601
Phone (262) 492-1626

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1083714679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 2ND ST N STE 220",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546012001",
            "telephone_number": "608-782-7738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 2ND ST N STE 220",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546012001",
            "telephone_number": "608-782-7738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKKEN",
        "first_name": "ANDREW",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-23",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.