Provider Demographics
NPI:1447292107
Name:PANK, SARA ANN (DC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:PANK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-0486
Mailing Address - Country:US
Mailing Address - Phone:715-538-2333
Mailing Address - Fax:715-538-2429
Practice Address - Street 1:36321 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9186
Practice Address - Country:US
Practice Address - Phone:715-538-2333
Practice Address - Fax:715-538-2429
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4149-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38963700Medicaid
WI113781061OtherTAX ID NUMBER
WI38963700Medicaid