Provider Demographics
NPI:1932382660
Name:BALDWIN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BALDWIN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-246-3706
Mailing Address - Street 1:203 LONG ST
Mailing Address - Street 2:SUITE B
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 LONG ST
Practice Address - Street 2:SUITE B
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908211Medicaid
NCT64491Medicare UPIN
NC8908211Medicaid