Provider Demographics
NPI:1891012803
Name:SPOT - BAUMGARTNER CHIROPRACTIC & NUTRITIONAL WELLNESS CENTER PLC
Entity Type:Organization
Organization Name:SPOT - BAUMGARTNER CHIROPRACTIC & NUTRITIONAL WELLNESS CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-458-7768
Mailing Address - Street 1:102 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:MI
Mailing Address - Zip Code:49256-1419
Mailing Address - Country:US
Mailing Address - Phone:517-458-7768
Mailing Address - Fax:517-458-3202
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:MI
Practice Address - Zip Code:49256-1419
Practice Address - Country:US
Practice Address - Phone:517-458-7768
Practice Address - Fax:517-458-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D600520OtherBCBS
MIJB008771Medicare UPIN
MIU88063Medicare PIN