MEDICARE: DR. JEFF BAURES 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	8887	TX

General Provider Information

NPI Number	:	1831192632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF BAURES D.C.

Provider Business Mailing Address
First Line	:	2417 SHALON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4843
Country	:	US
Telephone Number	:	817-891-2614
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 SHALON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4843
Country	:	US
Telephone Number	:	817-891-2614
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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