Provider Demographics
NPI:1619291986
Name:BAUMGART CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BAUMGART CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BAUMGART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-339-9225
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:WI
Mailing Address - Zip Code:53910-1298
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:139 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:WI
Practice Address - Zip Code:53910-9820
Practice Address - Country:US
Practice Address - Phone:608-339-9225
Practice Address - Fax:608-339-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3220261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center