Provider Demographics
NPI:1033178710
Name:BALDWIN, GARRY W (DC)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:W
Last Name:BALDWIN
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 1:61 RIVERWALK BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-5071
Mailing Address - Country:US
Mailing Address - Phone:843-252-0533
Mailing Address - Fax:
Practice Address - Street 1:61 RIVERWALK BLVD STE J
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5071
Practice Address - Country:US
Practice Address - Phone:843-252-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001940111N00000X
SC4847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01510Medicare UPIN
WAAB32166Medicare ID - Type Unspecified
WAAB32166Medicare PIN