Provider Demographics
NPI:1497731616
Name:BARON, DEREK T (D,C)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:T
Last Name:BARON
Suffix:
Gender:M
Credentials:D,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 LINCOLN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3674
Mailing Address - Country:US
Mailing Address - Phone:715-369-1001
Mailing Address - Fax:715-369-1003
Practice Address - Street 1:1903 LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3674
Practice Address - Country:US
Practice Address - Phone:715-369-1001
Practice Address - Fax:715-369-1003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3568111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU74852Medicare UPIN
WI001Medicare ID - Type Unspecified