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General NPI Number Information
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NPI Number | 1619429826
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Entity Type | Organization
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Legal Business Name | BARANOWSKI SPINALCARE LLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 1709 E. BRISTOL ST.
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City | ELKHART
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State | IN
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Zip | 46514-4553
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Country | US
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Telephone | 574-264-9174
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Fax | 574-262-4070
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Provider Business Mailing Address
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Address Line | 1709 E. BRISTOL ST.
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City | ELKHART
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State | IN
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Zip | 46514-4553
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Country | US
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Telephone | 574-264-9174
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Fax | 574-262-4070
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. TIMOTHY L BARANOWSKI
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Credential | D.C.
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Telephone | 574-264-9174
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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 | 08002547A
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License Number State | IN
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