Provider Demographics
NPI:1902903255
Name:TICKEL, PAMELA LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LOUISE
Last Name:TICKEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WELLS ST STE 340
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654
Mailing Address - Country:US
Mailing Address - Phone:312-329-9395
Mailing Address - Fax:312-329-9398
Practice Address - Street 1:400 N WELLS ST STE 340
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:312-329-9395
Practice Address - Fax:312-329-9398
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3041111N00000X
IL038-003947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000200101OtherBCBS
OHU88140Medicare UPIN
OHTI4064281Medicare PIN