Provider Demographics
NPI:1417095779
Name:BAIRD, WILLIAM THOMAS JR (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:BAIRD
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:T
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93421
Mailing Address - Country:US
Mailing Address - Phone:805-481-0754
Mailing Address - Fax:805-481-0756
Practice Address - Street 1:411 TRAFFIC WAY
Practice Address - Street 2:SUITE F
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:805-481-0754
Practice Address - Fax:805-481-0756
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC015668Medicaid
T05875Medicare UPIN
DC15668Medicare ID - Type Unspecified