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General NPI Number Information
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NPI Number | 1891909503
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Entity Type | Organization
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Legal Business Name | BAERTLEIN CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5027 GREEN BAY ROAD SUITE 118
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City | RACINE
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State | WI
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Zip | 53144-1771
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Country | US
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Telephone | 262-925-8600
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Fax | 262-925-8599
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Provider Business Mailing Address
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Address Line | 5027 GREEN BAY ROAD SUITE 118
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City | RACINE
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State | WI
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Zip | 53144-1771
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Country | US
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Telephone | 262-925-8600
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Fax | 262-925-8599
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Authorized Official
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Title or Position | OWNER
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Name | KRISTA MARY BAERTLEIN-LEBERFING
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Credential | D.C.
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Telephone | 262-925-8600
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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 | 3743-012
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License Number State | WI
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