Healthcare Provider Details

I. General information

NPI: 1649897893
Provider Name (Legal Business Name): MARY-MARGARET BAUKOL DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S WASHINGTON ST
LAKE CITY MN
55041-1034
US

IV. Provider business mailing address

208 FRANKLIN ST NW
PRESTON MN
55965-1005
US

V. Phone/Fax

Practice location:
  • Phone: 651-345-2785
  • Fax:
Mailing address:
  • Phone: 507-993-2447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6674
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: