Provider Demographics
NPI:1740461128
Name:KEVIN G. BACHE, DC,PC
Entity type:Organization
Organization Name:KEVIN G. BACHE, DC,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GREGROY
Authorized Official - Last Name:BACHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-833-8877
Mailing Address - Street 1:46 WESTMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1025
Mailing Address - Country:US
Mailing Address - Phone:410-833-8877
Mailing Address - Fax:410-833-3810
Practice Address - Street 1:46 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1025
Practice Address - Country:US
Practice Address - Phone:410-833-8877
Practice Address - Fax:410-833-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6243650001Medicare NSC
MD286MMedicare PIN