Provider Demographics
NPI:1639289176
Name:BAUCHOU, EDWARD ANDREW JR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANDREW
Last Name:BAUCHOU
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:7724 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2327
Mailing Address - Country:US
Mailing Address - Phone:434-237-4831
Mailing Address - Fax:434-237-1038
Practice Address - Street 1:7724 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2327
Practice Address - Country:US
Practice Address - Phone:434-237-4831
Practice Address - Fax:434-237-1038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor