Provider Demographics
NPI:1104939297
Name:BAXPLUS OF LITITZ PC
Entity type:Organization
Organization Name:BAXPLUS OF LITITZ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-627-0818
Mailing Address - Street 1:10 COPPERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9481
Mailing Address - Country:US
Mailing Address - Phone:717-627-0818
Mailing Address - Fax:
Practice Address - Street 1:10 COPPERFIELD CIR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9481
Practice Address - Country:US
Practice Address - Phone:717-627-0818
Practice Address - Fax:717-627-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005629L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001438381Medicaid
PA512170Medicare ID - Type Unspecified
PA001438381Medicaid