Provider Demographics
NPI:1255662094
Name:BAUER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BAUER CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-756-8700
Mailing Address - Street 1:301 N WASHINGTON ST STE 6
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1750
Mailing Address - Country:US
Mailing Address - Phone:573-756-8700
Mailing Address - Fax:573-756-8709
Practice Address - Street 1:301 N WASHINGTON ST STE 6
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1750
Practice Address - Country:US
Practice Address - Phone:573-756-8700
Practice Address - Fax:573-756-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU83584Medicare UPIN