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General NPI Number Information
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NPI Number | 1578756201
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Entity Type | Organization
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Legal Business Name | NEW LIFE SPINE CENTER LLC
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 1331 CONANT STREET #104
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City | MAUMEE
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State | OH
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Zip | 43537
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Country | US
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Telephone | 419-724-5433
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Fax | 419-720-6994
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Provider Business Mailing Address
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Address Line | 1331 CONANT STREET #104
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City | MAUMEE
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State | OH
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Zip | 43537
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Country | US
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Telephone | 419-724-5433
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Fax | 419-720-6994
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. THOMAS MATTHEW BAUR
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Credential | D.C.
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Telephone | 419-724-5433
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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 | 3371
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License Number State | OH
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