Jill M Mikkelson, DC
Individual provider Active NPI Chiropractor · Waunakee, WI
NPI 1972644706 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972644706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3655012 (WI)
- Practice address
- 1024 Quinn Drive
Waunakee, WI 53597 - Phone
- (608) 849-4521
- Fax
- (608) 849-8516
- NPI assigned
- Feb 12, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bakke Chiropractic Clinic SC
Practice addresses (Care Compare)
612 E Main St
Waunakee, WI 53597-1401
Phone (608) 849-9014
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051122000250 | WI | Practitioner - Chiropractic | 9537188388 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3655012 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bakke Chiropractic Clinic SC | Chiropractor | Current |
Accepting new patients |
| Waunakee Chiropractic, LLC | Chiropractor | Past |
Accepting new patients |
Locations
312 E North St
Deforest, WI 53532
Phone (608) 846-3333
612 E Main St
Waunakee, WI 53597
Phone (608) 849-9014
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3655012 | WI | Yes |
Addresses
Primary practice location
1024 Quinn Drive
Waunakee, WI 53597
Mailing address
5879 Woodland Drive
Waunakee, WI 53597
Phone (608) 849-4521
Other providers in Waunakee, 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.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.