Provider Demographics
NPI:1730157926
Name:BAUER, DARRYL V (DC)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:V
Last Name:BAUER
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 1:102 MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-4016
Mailing Address - Country:US
Mailing Address - Phone:337-786-4691
Mailing Address - Fax:337-786-4693
Practice Address - Street 1:102 MCNEESE ST
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-4016
Practice Address - Country:US
Practice Address - Phone:337-786-4691
Practice Address - Fax:337-786-4693
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1953598Medicaid
LA1953598Medicaid
LA59147Medicare ID - Type Unspecified