Provider Demographics
NPI:1063444982
Name:BAUER, SHAYNE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:MICHAEL
Last Name:BAUER
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 1:355 N PETERS AVE
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8258
Mailing Address - Country:US
Mailing Address - Phone:920-923-3322
Mailing Address - Fax:920-923-3940
Practice Address - Street 1:355 N PETERS AVE.
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-9400
Practice Address - Country:US
Practice Address - Phone:920-923-3322
Practice Address - Fax:920-923-3940
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3462111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035588Medicare PIN
WIU68661Medicare UPIN