Provider Demographics
NPI:1336251123
Name:PAKAN, JOHN MATHEW (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MATHEW
Last Name:PAKAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2610
Mailing Address - Country:US
Mailing Address - Phone:715-834-3541
Mailing Address - Fax:715-831-8285
Practice Address - Street 1:1219 10TH ST W
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2610
Practice Address - Country:US
Practice Address - Phone:715-834-3541
Practice Address - Fax:715-831-8285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38818300Medicaid
WI38818300Medicaid