Provider Demographics
NPI:1275926701
Name:BAUM, JENIFER (DC)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:BAUM
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 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1814
Mailing Address - Country:US
Mailing Address - Phone:262-646-6400
Mailing Address - Fax:262-646-6443
Practice Address - Street 1:403 GENESEE ST
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1814
Practice Address - Country:US
Practice Address - Phone:262-646-6400
Practice Address - Fax:262-646-6443
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5077-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor