Provider Demographics
NPI:1154406528
Name:BAUER, MICHAEL THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:BAUER
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 1:55 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1706
Mailing Address - Country:US
Mailing Address - Phone:610-588-6199
Mailing Address - Fax:610-588-1497
Practice Address - Street 1:55 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1706
Practice Address - Country:US
Practice Address - Phone:610-588-6199
Practice Address - Fax:610-588-1497
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007480L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2828610OtherAETNA
PABA628930OtherHIGHMARK BS
PA02819500OtherCAPITAL BLUE CROSS
PA1032757OtherASHN
PA2828610OtherAETNA
PA028679QVEMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER