Active NPI
Amy Erin Anderson, DC
- Chiropractor
- Deforest, WI
National Provider Identifier
1467550277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3408012
- Practice address
- 312 East North Street
Bakke Chiropractic Clinic SC
Deforest, WI 53532 - Phone
- (608) 846-3333
- Fax
- (608) 846-7033
- NPI assigned
- Sep 20, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3408012 | WI | Primary |
Addresses
Primary practice location
312 East North Street
Bakke Chiropractic Clinic SC
Deforest, WI 53532
Mailing address
312 East North Street
Bakke Chiropractic Clinic SC
Deforest, WI 53532
Phone (608) 846-3333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38957900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3408012 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467550277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 EAST NORTH STREET",
"address_2": "BAKKE CHIROPRACTIC CLINIC SC",
"city": "DEFOREST",
"state": "WI",
"postal_code": "53532",
"telephone_number": "608-846-3333",
"fax_number": "608-846-7033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 EAST NORTH STREET",
"address_2": "BAKKE CHIROPRACTIC CLINIC SC",
"city": "DEFOREST",
"state": "WI",
"postal_code": "53532",
"telephone_number": "608-846-3333",
"fax_number": "608-846-7033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "AMY",
"middle_name": "ERIN",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "3408012",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38957900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Deforest, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.