Provider Demographics
NPI:1518942796
Name:BASKIN, MITCHELL HAL (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:HAL
Last Name:BASKIN
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 1:1142 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1051
Mailing Address - Country:US
Mailing Address - Phone:610-740-9990
Mailing Address - Fax:610-437-9992
Practice Address - Street 1:1142 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1051
Practice Address - Country:US
Practice Address - Phone:610-740-9990
Practice Address - Fax:610-437-9992
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003918L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02723700OtherCAPITAL BLUE CROSS
PA02723700OtherCAPITAL BLUE CROSS
PA444176Medicare ID - Type Unspecified