Healthcare Provider Details

I. General information

NPI: 1770504847
Provider Name (Legal Business Name): BARON CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E SUMMIT AVE
WALES WI
53183-9551
US

IV. Provider business mailing address

104 E SUMMIT AVE
WALES WI
53183-9551
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: TIMOTHY DALE BARON
Title or Position: OWNER
Credential: D.C.
Phone: 262-968-5212