Provider Demographics
NPI:1912988544
Name:BALDWIN CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:BALDWIN CHIROPRACTIC HEALTH CENTER
Other - Org Name:DURAND CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:JACOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-684-3344
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-0002
Mailing Address - Country:US
Mailing Address - Phone:715-684-3344
Mailing Address - Fax:715-684-3345
Practice Address - Street 1:1640 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-0002
Practice Address - Country:US
Practice Address - Phone:715-684-3344
Practice Address - Fax:715-684-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38864500Medicaid
WI38758200Medicaid
WI38864500Medicaid
WIT62296Medicare UPIN