1952380057 NPI number — DR. BONNIE L BAUER DC

Table of content: DR. BONNIE L BAUER DC (NPI 1952380057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952380057 NPI number — DR. BONNIE L BAUER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUER
Provider First Name:
BONNIE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952380057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEWITT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52742-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-659-1667
Provider Business Mailing Address Fax Number:
563-221-9218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEWITT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52742-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-659-1667
Provider Business Practice Location Address Fax Number:
563-221-9218
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  AO5310 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00969 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1009696 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42-1502650 . This is a "TAX ID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 7567 . This is a "MIDLAND'S CHOICE" identifier . This identifiers is of the category "OTHER".




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