Provider Demographics
NPI:1952380057
Name:BAUER, BONNIE L (DC)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1404
Mailing Address - Country:US
Mailing Address - Phone:563-659-1667
Mailing Address - Fax:563-221-9218
Practice Address - Street 1:306 11TH ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1404
Practice Address - Country:US
Practice Address - Phone:563-659-1667
Practice Address - Fax:563-221-9218
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00969OtherBLUE CROSS BLUE SHIELD
IA1009696Medicaid
IA42-1502650OtherTAX ID
7567OtherMIDLAND'S CHOICE
7567OtherMIDLAND'S CHOICE
IA00969OtherBLUE CROSS BLUE SHIELD
IAU02963Medicare UPIN