Provider Demographics
NPI:1669546586
Name:BAUM, KEVIN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:BAUM
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 1:972 KEHRS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2402
Mailing Address - Country:US
Mailing Address - Phone:636-394-4101
Mailing Address - Fax:636-394-3022
Practice Address - Street 1:972 KEHRS MILL RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2402
Practice Address - Country:US
Practice Address - Phone:636-394-4101
Practice Address - Fax:636-394-3022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
179564OtherHEALTHLINK PPO
T83472OtherMERCY HEALTH CARE
179564OtherHEALTHLINK HMO
4402255OtherHEALTHCARE OF ALL STATES
3378OtherBCBS
T83472OtherMERCY HEALTH CARE
179564OtherHEALTHLINK HMO