Provider Demographics
NPI:1144213695
Name:BAX, DAVID JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:BAX
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 1:3945 EAGLE CREEK PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5617
Mailing Address - Country:US
Mailing Address - Phone:317-291-7246
Mailing Address - Fax:317-291-7268
Practice Address - Street 1:3945 EAGLE CREEK PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5617
Practice Address - Country:US
Practice Address - Phone:317-291-7246
Practice Address - Fax:317-291-7268
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001926A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200397300AMedicaid
IN000000387206OtherANTHEM BC/BS
IN193060Medicare PIN
INU72135Medicare UPIN