Provider Demographics
NPI:1578595716
Name:BALDWIN, CHARLES JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:BALDWIN
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 1:1746 KIVETT DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:TN
Mailing Address - Zip Code:37820-3626
Mailing Address - Country:US
Mailing Address - Phone:865-475-1703
Mailing Address - Fax:865-475-1703
Practice Address - Street 1:1746 KIVETT DR
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:TN
Practice Address - Zip Code:37820-3626
Practice Address - Country:US
Practice Address - Phone:865-475-1703
Practice Address - Fax:865-475-1703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000721111N00000X
NC1808111N00000X
TNML0000013693246QM0706X
TNMT-163458 (ASCP)246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB966OtherEMC
NC1808OtherNC STATE LICENSE
TNDC0000000721OtherTN STAT LICENSE
TN3676080Medicaid
TNB966OtherEMC
TNU26485Medicare UPIN