Nichole N Pankow, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4014-012 Issued in WI

Practice address

109 E Milwaukee St
Jefferson, WI 53549-1635

Phone

(920) 674-6627

Fax

(920) 674-6632

NPI assigned

Jun 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Chiropractic Care Centers, S.C.

  • Chiropractor
  • Jefferson, WI
  • NPI 1356482822
  NPD (past)
• Pain Relief Chiropractic

  • Chiropractor
  • Jefferson, WI
  • NPI 1295177673
  NPD (past)

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1497791933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 HILLSIDE DR",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491805",
            "telephone_number": "920-674-6627",
            "fax_number": "920-674-6632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E MILWAUKEE ST",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535491635",
            "telephone_number": "920-674-6627",
            "fax_number": "920-674-6632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANKOW",
        "first_name": "NICHOLE",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4014-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38955900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Ott
• Holly Rae Pagel, MSW
• Pain Relief Chiropractic
• Ann Elizabeth Palm, BA, RPH
• Tiffany Palm, PHARM.D.
• Mary Rose Parizek
• Susan Christine Parrish, MS/CCC-SLP
• Jennifer Nicole Penna
• Kelley Potila
• Kimberly Jo Propp, LPC

• Chiropractor in Jefferson, WI
• Providers in Jefferson, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.