Provider Demographics
NPI:1619045655
Name:DEREK T BARON
Entity Type:Organization
Organization Name:DEREK T BARON
Other - Org Name:INTEGRITY FAMILY CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-369-1001
Mailing Address - Street 1:1903 LINCOLN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3674
Mailing Address - Country:US
Mailing Address - Phone:715-369-1001
Mailing Address - Fax:715-369-1003
Practice Address - Street 1:1903 LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3674
Practice Address - Country:US
Practice Address - Phone:715-369-1001
Practice Address - Fax:715-369-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3568-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38911800Medicaid
WIU74852Medicare UPIN