Healthcare Provider Details

I. General information

NPI: 1255504288
Provider Name (Legal Business Name): BAUER CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S MAIN ST
LAS CRUCES NM
88005-3122
US

IV. Provider business mailing address

1265 S MAIN ST
LAS CRUCES NM
88005-3122
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-4494
  • Fax: 575-523-2526
Mailing address:
  • Phone: 575-524-4494
  • Fax: 575-523-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number972
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number972
License Number StateNM

VIII. Authorized Official

Name: LANE BAUER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 575-524-4494