Michael D Jacklitch, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

351 Issued in ND

Practice address

320 Dakota Ave
Wahpeton, ND 58075-4515

Phone

(701) 642-5600

Fax

(701) 642-8354

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477674794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 DAKOTA AVE",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754515",
            "telephone_number": "701-642-5600",
            "fax_number": "701-642-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 DAKOTA AVE",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754515",
            "telephone_number": "701-642-5600",
            "fax_number": "701-642-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKLITCH",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "351",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1381",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013374",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "90330JA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141827100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hornstein Family Chiropractic, LTD
• Andrea Hornstein, D.C.
• Innovis Health, LLC (Essentia Health Wahpeton ASC)
• Innovis Health, LLC. (Essentia Health Wahpeton Clinic)
• Mary Isom, PA-C
• Elley Jaskowski
• Jeffrey S. Withuski & Paula Sabbe DDS
• Bonita J Jenzen, APRN,CNP
• Erin Nicole Jirak, PA-C
• Daniel William Johnson, DPT

• Chiropractor in Wahpeton, ND
• Providers in Wahpeton, ND by specialty
• Chiropractor in North Dakota

• 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.
• 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.