Provider Demographics
NPI:1922639376
Name:BAIRD SPINE AND SPORT LLC
Entity Type:Organization
Organization Name:BAIRD SPINE AND SPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-293-7788
Mailing Address - Street 1:539 COPPER MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3996
Mailing Address - Country:US
Mailing Address - Phone:636-293-7788
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1168
Practice Address - Country:US
Practice Address - Phone:636-856-1260
Practice Address - Fax:636-856-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty