Provider Demographics
NPI:1245786102
Name:JDBAEK INC
Entity Type:Organization
Organization Name:JDBAEK INC
Other - Org Name:KEYSTONE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-351-7083
Mailing Address - Street 1:8604 PRESTON RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3318
Mailing Address - Country:US
Mailing Address - Phone:469-351-7083
Mailing Address - Fax:844-639-7851
Practice Address - Street 1:8604 PRESTON RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3318
Practice Address - Country:US
Practice Address - Phone:469-351-7083
Practice Address - Fax:844-639-7851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty