Provider Demographics
NPI:1235240433
Name:BALDWIN, JOANN (DC)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 JACKSON ST STE 307
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1898
Mailing Address - Country:US
Mailing Address - Phone:763-427-4597
Mailing Address - Fax:
Practice Address - Street 1:403 JACKSON ST STE 307
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1898
Practice Address - Country:US
Practice Address - Phone:763-427-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1734111N00000X
IA04277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52055BAOtherBLUE CROSS BLUE SHIELD