Provider Demographics
NPI:1659648731
Name:BAXTER, WILLIAM BLAIR (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAIR
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 1:5226 MAIN ST
Mailing Address - Street 2:UNIT D-2
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-7403
Mailing Address - Country:US
Mailing Address - Phone:931-488-8255
Mailing Address - Fax:931-488-9257
Practice Address - Street 1:5226 MAIN ST
Practice Address - Street 2:UNIT D-2
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7403
Practice Address - Country:US
Practice Address - Phone:931-488-8255
Practice Address - Fax:931-488-8257
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3018111N00000X
AL2344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor