MEDICARE: DR. MICHAEL ANGELO BAXTER DC

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	X010492-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	652562	OTHER	NY	ACN
2	1050112	OTHER	NY	ASH
3	3047630	OTHER	NY	CDPHP
4	000144094	OTHER	NY	EXCELLUS BC/BS
5	C10492-9W	OTHER	NY	WORK COMP

General Provider Information

NPI Number	:	1801889407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANGELO BAXTER DC

Provider Business Mailing Address
First Line	:	PO BOX 710
Second Line	:
City	:	WHITNEY POINT
State	:	NY
Zip	:	13862-0710
Country	:	US
Telephone Number	:	607-692-3961
Fax Number	:	607-692-2514

Provider Business Practice Location Address
First Line	:	2621 W MAIN STREET
Second Line	:
City	:	WHITNEY POINT
State	:	NY
Zip	:	13862
Country	:	US
Telephone Number	:	607-692-3961
Fax Number	:	607-692-2514

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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