MEDICARE: DR. KATHLEEN BAUMAN 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	X0069931	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X6128	OTHER	NY	EMPIRE BCBS
2	10013383	OTHER	NY	CDPHP

General Provider Information

NPI Number	:	1407933898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN BAUMAN D.C.

Provider Business Mailing Address
First Line	:	959 WASHINGTON AVENUE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1415
Country	:	US
Telephone Number	:	518-489-4811
Fax Number	:	518-489-6200

Provider Business Practice Location Address
First Line	:	959 WASHINGTON AVENUE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1415
Country	:	US
Telephone Number	:	518-489-4811
Fax Number	:	518-489-6200

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/01/2012

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