Healthcare Provider Details

I. General information

NPI: 1760483374
Provider Name (Legal Business Name): JOHN KEVIN BAER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 GREAT RD
BEDFORD MA
01730-2706
US

IV. Provider business mailing address

8 WINTHROP AVE
BEDFORD MA
01730-2223
US

V. Phone/Fax

Practice location:
  • Phone: 617-212-0073
  • Fax:
Mailing address:
  • Phone: 781-275-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1791
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: