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General NPI Number Information
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NPI Number | 1720007966
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Entity Type | Individual
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Provider Name | THOMAS MCLEOD BAADER DC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 41 SUMMERS WAY SUITE 103
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City | ROANOKE
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State | VA
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Zip | 24019-8291
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Country | US
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Telephone | 540-966-1423
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Fax | 540-966-4125
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Provider Business Mailing Address
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Address Line | PO BOX 25
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City | BLUE RIDGE
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State | VA
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Zip | 24064-0025
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Country | US
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Telephone | 540-966-1423
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Fax | 540-966-4125
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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 | 0104001231
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License Number State | VA
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