Provider Demographics
NPI:1639392640
Name:BAUER, MATTHEW JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BAUER
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 1:6905 E 96TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4448
Mailing Address - Country:US
Mailing Address - Phone:317-577-1990
Mailing Address - Fax:317-577-1993
Practice Address - Street 1:6905 E 96TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4448
Practice Address - Country:US
Practice Address - Phone:317-577-1990
Practice Address - Fax:317-577-1993
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002002A111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN202960577OtherTAX ID
IN202960577OtherTAX ID
INU90262Medicare UPIN