Provider Demographics
NPI:1326114984
Name:BAASTRUP, BIRGER I (DC)
Entity Type:Individual
Prefix:DR
First Name:BIRGER
Middle Name:I
Last Name:BAASTRUP
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 1:800 GLACIER AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1845
Mailing Address - Country:US
Mailing Address - Phone:907-463-5255
Mailing Address - Fax:907-463-5090
Practice Address - Street 1:800 GLACIER AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1845
Practice Address - Country:US
Practice Address - Phone:907-463-5255
Practice Address - Fax:907-463-5090
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA185111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152495Medicare ID - Type Unspecified