Provider Demographics
NPI:1285850297
Name:BAKER, JASON R (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
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 1:317 SANFORD DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-2573
Mailing Address - Country:US
Mailing Address - Phone:828-437-0888
Mailing Address - Fax:
Practice Address - Street 1:317 SANFORD DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-2573
Practice Address - Country:US
Practice Address - Phone:828-437-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8187111N00000X
NC2925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7250899OtherAETNA
833165OtherOPTUMHEALTH
NC5910123Medicaid
086A6OtherBLUECROSS BLUESHIELD OF NORTH CAROLINA
NC5910123Medicaid