Provider Demographics
NPI:1982244349
Name:BALDWIN, JACOB (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
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 1:5958 N CANTON CENTER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2766
Mailing Address - Country:US
Mailing Address - Phone:734-212-5828
Mailing Address - Fax:734-212-5827
Practice Address - Street 1:5958 N CANTON CENTER RD STE 300
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2766
Practice Address - Country:US
Practice Address - Phone:734-212-5828
Practice Address - Fax:734-212-5827
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor