Provider Demographics
NPI:1851427462
Name:BAXTER CHIROPRACTOR, P.C.
Entity Type:Organization
Organization Name:BAXTER CHIROPRACTOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-249-2225
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-0363
Mailing Address - Country:US
Mailing Address - Phone:978-249-2225
Mailing Address - Fax:978-249-7982
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2131
Practice Address - Country:US
Practice Address - Phone:978-249-2225
Practice Address - Fax:978-249-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU74054Medicare UPIN