Provider Demographics
NPI:1942638267
Name:BAUMANN, TUCKER JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:TUCKER
Middle Name:JOSEPH
Last Name:BAUMANN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1853
Mailing Address - Country:US
Mailing Address - Phone:507-532-2655
Mailing Address - Fax:
Practice Address - Street 1:104 W REDWOOD ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1853
Practice Address - Country:US
Practice Address - Phone:507-532-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007709111N00000X
MN5907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5907OtherLICENSE