Provider Demographics
NPI:1609981380
Name:BAUER, TODD JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JOSEPH
Last Name:BAUER
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:N8915 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-8707
Mailing Address - Country:US
Mailing Address - Phone:608-697-9994
Mailing Address - Fax:
Practice Address - Street 1:151 WISCONSIN DELLS PKWY S
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-8304
Practice Address - Country:US
Practice Address - Phone:608-253-0102
Practice Address - Fax:608-253-0102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4029-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38956600Medicaid