Provider Demographics
NPI:1760473938
Name:BAUTER, PHILIP EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EUGENE
Last Name:BAUTER
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 1:308 E VANDEREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:IL
Mailing Address - Zip Code:61942-9716
Mailing Address - Country:US
Mailing Address - Phone:217-837-2426
Mailing Address - Fax:
Practice Address - Street 1:124 SOUTH BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:IL
Practice Address - Zip Code:61942
Practice Address - Country:US
Practice Address - Phone:217-837-2426
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38003143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL285150Medicare ID - Type Unspecified