Provider Demographics
NPI:1255495594
Name:BAUMGARTEL, WALTER T (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:T
Last Name:BAUMGARTEL
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:45710-0008
Mailing Address - Country:US
Mailing Address - Phone:740-698-3181
Mailing Address - Fax:740-698-8314
Practice Address - Street 1:5550 ENNIS RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OH
Practice Address - Zip Code:45710-9259
Practice Address - Country:US
Practice Address - Phone:740-698-3181
Practice Address - Fax:740-888-1849
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000222039OtherBLUECROSS/BLUE SHIELD
OH2263438Medicaid
OHP00099438OtherRAILROAD MEDICARE
U83861Medicare UPIN
OH2263438Medicaid