Provider Demographics
NPI:1235239898
Name:BAKER, ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
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 1:100 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2330
Mailing Address - Country:US
Mailing Address - Phone:215-453-9008
Mailing Address - Fax:215-453-7494
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2330
Practice Address - Country:US
Practice Address - Phone:215-453-9008
Practice Address - Fax:215-453-7494
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC5177L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0637161000OtherBLUE CROSS ID
PABA733380OtherBLUE SHIELD ID
PA733380Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
PAU40610Medicare UPIN