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General NPI Number Information
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NPI Number | 1609388297
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Entity Type | Individual
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Provider Name | LOGAN BAXTER DC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 13207 E STATE ROUTE 169 STE B
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City | DEWEY
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State | AZ
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Zip | 86327-0018
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Country | US
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Telephone | 928-499-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 841 S MANZANITA BLVD
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City | DEWEY
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State | AZ
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Zip | 86327-7119
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Country | US
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Telephone | 208-870-6894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9283
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License Number State | AZ
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