Provider Demographics
NPI:1609039395
Name:PAUL D BAUMGARDNER DC PA
Entity Type:Organization
Organization Name:PAUL D BAUMGARDNER DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-732-3200
Mailing Address - Street 1:2663 AIRPORT PULLING RD S
Mailing Address - Street 2:D-104
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-4875
Mailing Address - Country:US
Mailing Address - Phone:239-793-3200
Mailing Address - Fax:239-793-0756
Practice Address - Street 1:2663 AIRPORT PULLING RD S
Practice Address - Street 2:D-104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4875
Practice Address - Country:US
Practice Address - Phone:239-793-3200
Practice Address - Fax:239-793-0756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9592261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center