Provider Demographics
NPI:1174541791
Name:BAUMGART, SHERRY LEA (DC)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LEA
Last Name:BAUMGART
Suffix:
Gender:F
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:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:WI
Mailing Address - Zip Code:53910-1298
Mailing Address - Country:US
Mailing Address - Phone:608-339-9225
Mailing Address - Fax:608-339-9225
Practice Address - Street 1:139 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:WI
Practice Address - Zip Code:53910
Practice Address - Country:US
Practice Address - Phone:608-339-9225
Practice Address - Fax:608-339-9225
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3220-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38888100Medicaid
WI70817Medicare ID - Type Unspecified
WI38888100Medicaid