Healthcare Provider Details

I. General information

NPI: 1497702468
Provider Name (Legal Business Name): TIMOTHY DALE BARON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E SUMMIT AVE
WALES WI
53183-9724
US

IV. Provider business mailing address

104 E SUMMIT AVE
WALES WI
53183-9724
US

V. Phone/Fax

Practice location:
  • Phone: 262-968-5212
  • Fax: 262-968-5214
Mailing address:
  • Phone: 262-968-5212
  • Fax: 262-968-5214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2526
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: