MEDICARE: DR. STACIE M BALDWIN D.C.

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	35-2268554	IL

General Provider Information

NPI Number	:	1386732311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACIE M BALDWIN D.C.

Provider Business Mailing Address
First Line	:	313 HILLTOP DR
Second Line	:
City	:	GRAYVILLE
State	:	IL
Zip	:	62844-1824
Country	:	US
Telephone Number	:	618-384-8592
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 W COMMERCE ST
Second Line	:
City	:	GRAYVILLE
State	:	IL
Zip	:	62844-1565
Country	:	US
Telephone Number	:	618-375-9992
Fax Number	:	618-375-9991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	05/08/2014

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