Provider Demographics
NPI:1164669768
Name:DR. BAUER'S ADVANCED WELLNESS
Entity type:Organization
Organization Name:DR. BAUER'S ADVANCED WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-299-9800
Mailing Address - Street 1:2356 MOORE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3017
Mailing Address - Country:US
Mailing Address - Phone:616-299-9800
Mailing Address - Fax:619-299-9889
Practice Address - Street 1:2356 MOORE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3017
Practice Address - Country:US
Practice Address - Phone:616-299-9800
Practice Address - Fax:619-299-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty