Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038006204 | IL |
N | 111NS0005X | Chiropractic Sports Physician | 038006204 | IL |
NPI | 1003863275 |
---|---|
Provider Name | Dr. Joseph John Baric JR. |
First Address | Arlington Hts, IL 60004 |
Second Address | Arlington Hts, IL 60004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 30/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01618138 | BCBS (01) | IL |
038006204 | (05) | IL |
T39156 | (02) |