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General NPI Number Information
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NPI Number | 1407124621
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Entity Type | Organization
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Legal Business Name | MTB 1, INC.
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 171 N NELTNOR BLVD # A
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City | WEST CHICAGO
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State | IL
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Zip | 60185-2315
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Country | US
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Telephone | 630-231-0777
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Fax | 630-231-0777
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Provider Business Mailing Address
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Address Line | 956 PARK HILL CIRCLE
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City | AURORA
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State | IL
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Zip | 60502-9093
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Country | US
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Telephone | 630-585-5283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL L BAUER
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Credential | D.C.
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Telephone | 260-494-6071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-010351
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License Number State | IL
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