Provider Demographics
NPI:1629135355
Name:BAXTER, JANIE W (DC CCST)
Entity Type:Individual
Prefix:MRS
First Name:JANIE
Middle Name:W
Last Name:BAXTER
Suffix:
Gender:F
Credentials:DC CCST
Other - Prefix:DR
Other - First Name:JANIE
Other - Middle Name:W
Other - Last Name:DEERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 BURKETTS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539
Mailing Address - Country:US
Mailing Address - Phone:912-375-4893
Mailing Address - Fax:912-375-9872
Practice Address - Street 1:171 BURKETTS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539
Practice Address - Country:US
Practice Address - Phone:912-375-4893
Practice Address - Fax:912-375-9872
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000977111N00000X
NC692111N00000X
KY2831111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
620580Medicare UPIN