Provider Demographics
NPI:1871133306
Name:BAIRD, JOSHUA DAVID (DC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:BAIRD
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 1:539 COPPER MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3996
Mailing Address - Country:US
Mailing Address - Phone:636-293-7788
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1168
Practice Address - Country:US
Practice Address - Phone:636-856-1260
Practice Address - Fax:636-856-1245
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020000951111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty