Provider Demographics
NPI:1912240599
Name:BALDWIN, FREDERICK LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:LYNN
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 1:2304 BARDIN RD
Mailing Address - Street 2:201
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3850
Mailing Address - Country:US
Mailing Address - Phone:817-789-4225
Mailing Address - Fax:817-840-6407
Practice Address - Street 1:2304 BARDIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3850
Practice Address - Country:US
Practice Address - Phone:817-789-4225
Practice Address - Fax:817-840-6407
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1821494113Medicare NSC