Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104001266 | VA |
NPI | 1003838350 |
---|---|
Provider Name | Dr. Karen Reese Baader |
First Address | Roanoke, VA 24007-1364 |
Second Address | Roanoke, VA 24019-8291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
281806 | ANTHEM BLUE CROSS (01) | VA |
4579046 | AETNA (01) | VA |