Healthcare Provider Details

I. General information

NPI: 1679620009
Provider Name (Legal Business Name): DR CHRISTINE J BAUER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FULTON ST
WESTBURY NY
11590-1222
US

IV. Provider business mailing address

401 FULTON ST
WESTBURY NY
11590-1222
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-7770
  • Fax:
Mailing address:
  • Phone: 516-333-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberXOO4598 1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001796 1
License Number StateNY

VIII. Authorized Official

Name: DR. CHRISTINE JUDITH BAUER
Title or Position: PHYSCIAN
Credential: DC,LAC.
Phone: 516-333-7770