Provider Demographics
NPI:1811936354
Name:BALDWIN, JEFFREY KENT (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
Last Name:BALDWIN
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 1:203B LONG ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9518
Mailing Address - Country:US
Mailing Address - Phone:336-246-3706
Mailing Address - Fax:336-246-3932
Practice Address - Street 1:203 B LONG STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9518
Practice Address - Country:US
Practice Address - Phone:336-246-3706
Practice Address - Fax:336-246-3932
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-08211Medicaid
NC2454058Medicare PIN
NC89-08211Medicaid