Healthcare Provider Details

I. General information

NPI: 1992875298
Provider Name (Legal Business Name): BAIRD CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N JUDD PKWY NE STE 102
FUQUAY VARINA NC
27526-2624
US

IV. Provider business mailing address

320 N JUDD PKWY NE STE 102
FUQUAY VARINA NC
27526-2624
US

V. Phone/Fax

Practice location:
  • Phone: 919-557-5811
  • Fax: 919-557-8236
Mailing address:
  • Phone: 919-557-5811
  • Fax: 919-557-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1670
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1670
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1670
License Number StateNC

VIII. Authorized Official

Name: DR. BONNIE SMITHYMAN BAIRD
Title or Position: PRESIDENT
Credential: DC CCSP
Phone: 919-557-5811