Provider Demographics
NPI:1053654616
Name:BAER, MICHAEL LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LESLIE
Last Name:BAER
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 1:45 HANSEN DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1677
Mailing Address - Country:US
Mailing Address - Phone:732-284-7679
Mailing Address - Fax:
Practice Address - Street 1:45 HANSEN DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1677
Practice Address - Country:US
Practice Address - Phone:732-284-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00179500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor