Provider Demographics
NPI:1598871220
Name:BAUMGARTNER, JOSHUA DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DANIEL
Last Name:BAUMGARTNER
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 1:9756 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-9557
Mailing Address - Country:US
Mailing Address - Phone:517-458-6434
Mailing Address - Fax:517-458-3202
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:MI
Practice Address - Zip Code:49256-1419
Practice Address - Country:US
Practice Address - Phone:517-458-7768
Practice Address - Fax:517-458-3202
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D61058OtherBCBS
MI0D61058OtherBCBS
MI0N91130Medicare ID - Type Unspecified