Provider Demographics
NPI:1063500742
Name:BAKER, JOHN RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
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 1:1420 MCCANN RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3851
Mailing Address - Country:US
Mailing Address - Phone:903-753-5400
Mailing Address - Fax:903-757-5604
Practice Address - Street 1:1420 MCCANN RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3851
Practice Address - Country:US
Practice Address - Phone:903-753-5400
Practice Address - Fax:903-757-5604
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V0410OtherBLUE CROSS/BLUE SHIELD
TX8V0410OtherBLUE CROSS/BLUE SHIELD
TX609561Medicare ID - Type UnspecifiedMEDICARE NUMBER