Provider Demographics
NPI:1891862025
Name:BAIRD, BONNIE SMITHYMAN (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:SMITHYMAN
Last Name:BAIRD
Suffix:
Gender:F
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N JUDD PRKWY NE
Mailing Address - Street 2:STE 102
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-557-5811
Mailing Address - Fax:919-557-8236
Practice Address - Street 1:320 N JUDD PRKWY NE
Practice Address - Street 2:STE 102
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-557-5811
Practice Address - Fax:919-557-8236
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1670NC111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0809AOtherBCBS
330573OtherACN
6320398OtherCIGNA
T90816Medicare UPIN
330573OtherACN