Provider Demographics
NPI:1578588216
Name:BAUDILLE, JOSEPH D (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:BAUDILLE
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 1:1518 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3421
Mailing Address - Country:US
Mailing Address - Phone:718-837-0048
Mailing Address - Fax:718-837-7145
Practice Address - Street 1:1518 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3421
Practice Address - Country:US
Practice Address - Phone:718-837-0048
Practice Address - Fax:718-837-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004502-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX24641OtherEMPIRE BLUE CROSS BLUE SHIELD
NYX24641Medicare PIN