Provider Demographics
NPI:1063420073
Name:BAXTER, THOMAS CAMPBELL (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CAMPBELL
Last Name:BAXTER
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 1:177 SANTA ROSA ST
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-2431
Mailing Address - Country:US
Mailing Address - Phone:805-544-5779
Mailing Address - Fax:805-544-5786
Practice Address - Street 1:177 SANTA ROSA ST
Practice Address - Street 2:STE 1
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-2431
Practice Address - Country:US
Practice Address - Phone:805-544-5779
Practice Address - Fax:805-544-5786
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18682Medicare UPIN
DC18323AMedicare ID - Type Unspecified