Provider Demographics
NPI:1649243833
Name:BAUMAN, WILLIAM O (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:O
Last Name:BAUMAN
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-3192
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007940R111N00000X
NYX006841-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGU039978OtherMEDICARE GROUP
PA001835819001Medicaid
NY02164230Medicaid
NYCC8362OtherRR MEDICARE GROUP
NYP00324438OtherRR MEDICARE PIN
PA350051594OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
U32145Medicare UPIN
PA047404N9SMedicare ID - Type Unspecified
PA001835819001Medicaid