Provider Demographics
NPI:1619117090
Name:BAXTER, WILLIAM NATHANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NATHANIEL
Last Name:BAXTER
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 1:1353 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3425
Mailing Address - Country:US
Mailing Address - Phone:937-554-9582
Mailing Address - Fax:937-252-4402
Practice Address - Street 1:1353 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3425
Practice Address - Country:US
Practice Address - Phone:937-554-9582
Practice Address - Fax:937-252-4402
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31064111N00000X
OHDC-4070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor