Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | AA185 | AK |
NPI | 1326114984 |
---|---|
Provider Name | Dr. Birger I Baastrup |
First Address | Juneau, AK 99801-1845 |
Second Address | Juneau, AK 99801-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 15/11/2010 |