Provider Demographics
NPI:1720007966
Name:BAADER, THOMAS MCLEOD (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MCLEOD
Last Name:BAADER
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:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-0025
Mailing Address - Country:US
Mailing Address - Phone:540-966-1423
Mailing Address - Fax:540-966-4125
Practice Address - Street 1:41 SUMMERS WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-8291
Practice Address - Country:US
Practice Address - Phone:540-966-1423
Practice Address - Fax:540-966-4125
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA170913OtherSOUTHERN HEALTH
VA281817OtherANTHEM BLUE CROSS
VA197924OtherANTHEM
VA350039206OtherRAILROAD MEDICARE
VA5115029OtherAETNA
VA170913OtherSOUTHERN HEALTH