Provider Demographics
NPI:1033157474
Name:BAUMGARDNER, KATHLEEN D (D C)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:D
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N MAPLE AVE
Mailing Address - Street 2:SUITE G2
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9415
Mailing Address - Country:US
Mailing Address - Phone:856-983-5422
Mailing Address - Fax:856-983-6579
Practice Address - Street 1:230 N MAPLE AVE
Practice Address - Street 2:SUITE G2
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9415
Practice Address - Country:US
Practice Address - Phone:856-983-5422
Practice Address - Fax:856-983-6579
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ556065XAGMedicare PIN