Provider Demographics
NPI:1023024262
Name:BAKER, RYAN C (DC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:BAKER
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 1:333 SW 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2513
Mailing Address - Country:US
Mailing Address - Phone:541-471-0701
Mailing Address - Fax:541-471-9577
Practice Address - Street 1:333 SW 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2513
Practice Address - Country:US
Practice Address - Phone:541-471-0701
Practice Address - Fax:541-471-9577
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR73 3657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130726Medicare PIN