Provider Demographics
NPI:1992824536
Name:BAXTER, CHARLES E (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:BAXTER
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 1:109 LUMBER ST
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2219
Mailing Address - Country:US
Mailing Address - Phone:978-249-2225
Mailing Address - Fax:978-249-7982
Practice Address - Street 1:123 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-2131
Practice Address - Country:US
Practice Address - Phone:978-249-2225
Practice Address - Fax:978-249-7982
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1612999Medicaid
MAY45216Medicare ID - Type Unspecified
MAU74054Medicare UPIN