Provider Demographics
NPI:1740296680
Name:BAUER, MICHAEL LEONARD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:BAUER
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 1:171A N NELTNOR BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2315
Mailing Address - Country:US
Mailing Address - Phone:630-231-0777
Mailing Address - Fax:630-231-0667
Practice Address - Street 1:171 N NELTNOR BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2315
Practice Address - Country:US
Practice Address - Phone:630-231-0777
Practice Address - Fax:630-231-0667
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038-010351OtherIL LICENSE NUMBER
ILK27015Medicare ID - Type Unspecified
IL038-010351OtherIL LICENSE NUMBER