Provider Demographics
NPI:1770504847
Name:BARON CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BARON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-968-5212
Mailing Address - Street 1:104 E SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9551
Mailing Address - Country:US
Mailing Address - Phone:262-968-5212
Mailing Address - Fax:262-968-5214
Practice Address - Street 1:104 E SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9551
Practice Address - Country:US
Practice Address - Phone:262-968-5212
Practice Address - Fax:262-968-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========011OtherBLUE CROSS