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General NPI Number Information
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NPI Number | 1891862025
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Entity Type | Individual
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Provider Name | BONNIE SMITHYMAN BAIRD DC CCSP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 320 N JUDD PRKWY NE STE 102
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City | FUQUAY VARINA
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State | NC
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Zip | 27526
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Country | US
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Telephone | 919-557-5811
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Fax | 919-557-8236
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Provider Business Mailing Address
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Address Line | 320 N JUDD PRKWY NE STE 102
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City | FUQUAY VARINA
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State | NC
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Zip | 27526
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Country | US
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Telephone | 919-557-5811
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Fax | 919-557-8236
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1670NC
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License Number State | NC
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