Provider Demographics
NPI:1255547519
Name:BALDWIN FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BALDWIN FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-617-0777
Mailing Address - Street 1:5657 S HIMALAYA ST
Mailing Address - Street 2:250
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5307
Mailing Address - Country:US
Mailing Address - Phone:303-617-0777
Mailing Address - Fax:
Practice Address - Street 1:5657 S HIMALAYA ST
Practice Address - Street 2:250
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5307
Practice Address - Country:US
Practice Address - Phone:303-617-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5069111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO526148Medicare ID - Type Unspecified
CO810383Medicare PIN
COU98806Medicare UPIN