Gregg Nelson Bakke, DC
Individual provider Active NPI Chiropractor · Deforest, WI
NPI 1689772485 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689772485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1460012 (WI)
- 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
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1460012 | WI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1460012 | WI | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 391253374030 | Other | WI | BLUE CROSS BLUE SHIELD |
| 38759100 | Medicaid | WI |
Other providers in Deforest, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.