Provider Demographics
NPI:1528263290
Name:BAXTER CHIROPRACTIC PA
Entity type:Organization
Organization Name:BAXTER CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DION
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-454-0990
Mailing Address - Street 1:13782 BLUESTEM CT
Mailing Address - Street 2:STE. 100
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8776
Mailing Address - Country:US
Mailing Address - Phone:218-454-0990
Mailing Address - Fax:218-829-2875
Practice Address - Street 1:13782 BLUESTEM CT
Practice Address - Street 2:STE 100
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8776
Practice Address - Country:US
Practice Address - Phone:218-454-0990
Practice Address - Fax:218-829-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260323962OtherFEDERAL TAX