MEDICARE: DR. ANGELA LOUISE BAXTER 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	38010854	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10032066	OTHER	IL	BLUE CROSS BLUE SHIELD IL
2	208744937	OTHER	IL	TAX ID

General Provider Information

NPI Number	:	1881743169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA LOUISE BAXTER D.C.

Provider Business Mailing Address
First Line	:	3313 PATRIOT COURT
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-3782
Country	:	US
Telephone Number	:	618-993-9910
Fax Number	:	618-993-2774

Provider Business Practice Location Address
First Line	:	3313 PATRIOT COURT
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-3782
Country	:	US
Telephone Number	:	618-993-9910
Fax Number	:	618-993-2774

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/19/2012

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