Provider Demographics
NPI:1992740013
Name:BACHE, KEVIN G (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:BACHE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:46 WESTMINSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1025
Mailing Address - Country:US
Mailing Address - Phone:410-456-9158
Mailing Address - Fax:410-833-3810
Practice Address - Street 1:46 WESTMINSTER RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1025
Practice Address - Country:US
Practice Address - Phone:410-833-8877
Practice Address - Fax:410-833-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU61523Medicare UPIN