Provider Demographics
NPI:1154453330
Name:BAIETTI, JOHN J (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BAIETTI
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 1:6804 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2312
Mailing Address - Country:US
Mailing Address - Phone:773-586-2340
Mailing Address - Fax:773-586-2368
Practice Address - Street 1:6804 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2312
Practice Address - Country:US
Practice Address - Phone:773-586-2340
Practice Address - Fax:773-586-2368
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605502OtherBLUE CROSS BLUE SHIELD ID
ILU49787Medicare UPIN
IL345440Medicare ID - Type Unspecified