Provider Demographics
NPI:1700855004
Name:BAUER, PETER S (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
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 1:3271 TURTLE LAKE CT SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5018
Mailing Address - Country:US
Mailing Address - Phone:404-388-7999
Mailing Address - Fax:770-955-2766
Practice Address - Street 1:1475 TERRELL MILL RD SE
Practice Address - Street 2:SUITE 108
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6049
Practice Address - Country:US
Practice Address - Phone:404-388-7999
Practice Address - Fax:770-955-2766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU64183Medicare UPIN
GA35ZCDNLMedicare ID - Type Unspecified