Healthcare Provider Details

I. General information

NPI: 1144213695
Provider Name (Legal Business Name): DAVID JOSEPH BAX D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 EAGLE CREEK PKWY SUITE D
INDIANAPOLIS IN
46254-5617
US

IV. Provider business mailing address

3945 EAGLE CREEK PKWY SUITE D
INDIANAPOLIS IN
46254-5617
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-7246
  • Fax: 317-291-7268
Mailing address:
  • Phone: 317-291-7246
  • Fax: 317-291-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: