MEDICARE: BAUER CHIROPRACTIC 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	261QM2500X	Medical Specialty Clinic/Center	972	NM
2	111N00000X	Chiropractor	972	NM

General Provider Information

NPI Number	:	1255504288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUER CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1265 S MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3122
Country	:	US
Telephone Number	:	575-524-4494
Fax Number	:	575-523-2526

Provider Business Practice Location Address
First Line	:	1265 S MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3122
Country	:	US
Telephone Number	:	575-524-4494
Fax Number	:	575-523-2526

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LANE BAUER
Credential	:	D.C.
Telephone Number	:	575-524-4494

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	10/23/2012

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