Provider Demographics
NPI:1548309305
Name:BAUER, RICHARD K (CH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:BAUER
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4611
Mailing Address - Country:US
Mailing Address - Phone:970-352-4312
Mailing Address - Fax:970-336-5944
Practice Address - Street 1:1502 9TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4611
Practice Address - Country:US
Practice Address - Phone:970-352-4312
Practice Address - Fax:970-336-5944
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1433111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC11493Medicare PIN