Provider Demographics
NPI:1023376811
Name:DR EDWARD A BAUCHOU JR DC PC
Entity Type:Organization
Organization Name:DR EDWARD A BAUCHOU JR DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUCHOU
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:434-237-4831
Mailing Address - Street 1:7724 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2327
Mailing Address - Country:US
Mailing Address - Phone:434-237-4831
Mailing Address - Fax:434-237-1038
Practice Address - Street 1:7724 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2327
Practice Address - Country:US
Practice Address - Phone:434-237-4831
Practice Address - Fax:434-237-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0104001096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty