Provider Demographics
NPI:1538214549
Name:BAUR, THOMAS MATTHEW (DC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:BAUR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 CONANT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-724-5433
Mailing Address - Fax:419-720-6994
Practice Address - Street 1:1331 CONANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-724-5433
Practice Address - Fax:419-720-6994
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2483227Medicaid
OHBA411672Medicare UPIN
OH2483227Medicaid