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General NPI Number Information
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NPI Number | 1417114547
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Entity Type | Organization
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Legal Business Name | BAER CHIROPRACTIC & WELLNESS INC.
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 11/29/2008
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Provider Practice Location Address
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Address Line | 2585 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61114-5643
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Country | US
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Telephone | 815-636-9450
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Fax | 815-636-9443
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Provider Business Mailing Address
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Address Line | 2585 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61114-5643
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Country | US
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Telephone | 815-636-9450
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Fax | 815-636-9443
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Authorized Official
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Title or Position | PRESIDENT/CHIROPRACTOR
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Name | DR. BRENDA MICHELLE BAER
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Credential | D.C.
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Telephone | 815-636-9450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NP0017X
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Taxonomy Name | Pediatric Chiropractor
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License Number | 038008941
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License Number State | IL
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