Provider Demographics
NPI:1285948778
Name:BALDWIN CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:BALDWIN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNEY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-223-5111
Mailing Address - Street 1:1415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-2109
Mailing Address - Country:US
Mailing Address - Phone:574-223-5111
Mailing Address - Fax:
Practice Address - Street 1:1415 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-2109
Practice Address - Country:US
Practice Address - Phone:574-223-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001587A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN350050854OtherRAILROAD MEDICARE PIN
IN200086940AMedicaid
IN200086940AMedicaid
IN350050854OtherRAILROAD MEDICARE PIN