Provider Demographics
NPI:1720475700
Name:BAUMAN, MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:BAUMAN
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 1:38 EISEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1618
Mailing Address - Country:US
Mailing Address - Phone:716-866-4524
Mailing Address - Fax:
Practice Address - Street 1:38 EISEMAN AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1618
Practice Address - Country:US
Practice Address - Phone:716-866-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70012656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor