MEDICARE: BAXPLUS OF LITITZ PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC005629L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104939297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAXPLUS OF LITITZ PC

Provider Business Mailing Address
First Line	:	10 COPPERFIELD CIR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-9481
Country	:	US
Telephone Number	:	717-627-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 COPPERFIELD CIR
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-9481
Country	:	US
Telephone Number	:	717-627-0818
Fax Number	:	717-627-2355

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD WAGNER
Credential	:	DC
Telephone Number	:	717-627-0818

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	02/28/2014

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Directions to “BAXPLUS OF LITITZ PC ” Practice Location

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