Angela Baxter LLC
Organization Active NPI Chiropractor · Herrin, IL
NPI 1265637755 · NPPES record last updated Sep 20, 2012
Key facts
- NPI
- 1265637755
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038010854 (IL)
- Legal business name
- ANGELA BAXTER LLC
- Practice address
- 3313 Patriot Court
Herrin, IL 62948-3782 - Phone
- (618) 993-9910
- Fax
- (618) 993-2774
- NPI assigned
- Jun 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Angela Louise Baxter, D.C.
- Title
- Owner
- Phone
- (618) 993-9910
Practitioners 14
-
Angela Louise Baxter, D.C.
-
Ryan Power, DC
-
Taylor E Scott, DC
-
William Edward Copes, BADC
-
Ryan August Gullett, D.C
-
Curtis Ryan Harper, D.C.
-
Joshua Hottes, DC
-
Kent McMahon, D.C.
-
Bradley Edward Burns, D.C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070619000262 | IL | Part B Supplier - Clinic/Group Practice | 1850490707 |
Receives reassigned benefits from 3 practitioners Practice locations: Herrin, IL |
National Provider Directory
Locations
3313 Patriot Ct
Herrin, IL 62948
Phone (618) 993-9910
1508 Sioux Dr
Ste B
Marion, IL 62959
Phone (618) 405-9330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 038010854 | IL | Yes |
Addresses
Primary practice location
3313 Patriot Court
Herrin, IL 62948-3782
Mailing address
3313 Patriot Court
Herrin, IL 62948-3782
Phone (618) 993-9910
Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.