Provider Demographics
NPI:1922570951
Name:BAIETTO, ANNIE LILI
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:LILI
Last Name:BAIETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 RIDGEDALE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1786
Mailing Address - Country:US
Mailing Address - Phone:952-314-7035
Mailing Address - Fax:952-426-3413
Practice Address - Street 1:12455 RIDGEDALE DR STE 203
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1786
Practice Address - Country:US
Practice Address - Phone:952-314-7035
Practice Address - Fax:952-426-3413
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor