Provider Demographics
NPI:1043350101
Name:BAK, JOSEPH CLARE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CLARE
Last Name:BAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1416
Mailing Address - Country:US
Mailing Address - Phone:612-968-5259
Mailing Address - Fax:
Practice Address - Street 1:1 5TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3778
Practice Address - Country:US
Practice Address - Phone:605-882-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor