Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038-003870 | IL |
NPI | 1518025576 |
---|---|
Provider Name | Dr. Warren Baskin |
First Address | Northbrook, IL 60062-1447 |
Second Address | Northbrook, IL 60062-1447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 22/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06082032 | BLUE CROSS BLUE SHIELD (01) | IL |