Provider Demographics
NPI:1144239195
Name:BAEK, ROBERT S (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BAEK
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 1:2681 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2810
Mailing Address - Country:US
Mailing Address - Phone:213-383-7030
Mailing Address - Fax:213-383-7031
Practice Address - Street 1:2681 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 2201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2810
Practice Address - Country:US
Practice Address - Phone:213-383-7030
Practice Address - Fax:213-383-7031
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor