Provider Demographics
NPI:1073965547
Name:BARON, LEVI (DC)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:BARON
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 1:814 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3541
Mailing Address - Country:US
Mailing Address - Phone:605-342-0748
Mailing Address - Fax:605-342-0769
Practice Address - Street 1:814 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3541
Practice Address - Country:US
Practice Address - Phone:605-342-0748
Practice Address - Fax:605-342-0769
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1293111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor