Provider Demographics
NPI:1497702468
Name:BARON, TIMOTHY DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DALE
Last Name:BARON
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 1:104 E SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9724
Mailing Address - Country:US
Mailing Address - Phone:262-968-5212
Mailing Address - Fax:262-968-5214
Practice Address - Street 1:104 E SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9724
Practice Address - Country:US
Practice Address - Phone:262-968-5212
Practice Address - Fax:262-968-5214
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391673814011OtherBLUE CROSS
WI391673814011OtherBLUE CROSS
T90682Medicare UPIN