Provider Demographics
NPI:1417114547
Name:BAER CHIROPRACTIC & WELLNESS INC.
Entity Type:Organization
Organization Name:BAER CHIROPRACTIC & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-636-9450
Mailing Address - Street 1:2585 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5643
Mailing Address - Country:US
Mailing Address - Phone:815-636-9450
Mailing Address - Fax:815-636-9443
Practice Address - Street 1:2585 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5643
Practice Address - Country:US
Practice Address - Phone:815-636-9450
Practice Address - Fax:815-636-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008941111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132030OtherBCBS
IL038008941Medicaid
IL411508205OtherHSM/ECOH
IL411508205OtherHSM/ECOH
IL10132030OtherBCBS
ILU82027Medicare UPIN