=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477739480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAUMAN CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2008
-----------------------------------------------------
Last Update Date | 01/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 733 N PINE ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53105-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-763-8399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 733 N PINE ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53105-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-763-8399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RYAN S BAUMAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 262-763-8399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4178-012
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------