Baldwin Chiropractic Health Center
Organization Active NPI Chiropractor · Baldwin, WI
NPI 1912988544 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1912988544
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 1496 (WI)
- Legal business name
- BALDWIN CHIROPRACTIC HEALTH CENTER
- Practice address
- 1640 10TH Avenue
Baldwin, WI 54002-0002 - Phone
- (715) 684-3344
- Fax
- (715) 684-3345
- NPI assigned
- Nov 10, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Douglas Earl Jacot, DC
- Title
- President
- Phone
- (715) 684-3344
Other NPIs on the same Medicare enrollment 1
Practitioners 2
-
Teri L Adams, D.C.
-
James Greenwood, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070601000092 | WI | Part B Supplier - Clinic/Group Practice | 2163520958 |
Receives reassigned benefits from 2 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Baldwin, WI |
National Provider Directory
Locations
1640 10th Ave
Baldwin, WI 54002
Phone (715) 684-3344
319 W Main St
Durand, WI 54736
Phone (715) 292-2951
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 1496 | WI | Yes |
Addresses
Primary practice location
1640 10TH Avenue
Baldwin, WI 54002-0002
Mailing address
PO Box 2
Baldwin, WI 54002-0002
Phone (715) 684-3344
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38864500 | Medicaid | WI | |
| 38758200 | Medicaid | WI |
Other names
- Durand Chiropractic Health Center
Other providers in Baldwin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. 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.