Provider Demographics
NPI:1336466143
Name:BAKER, BENJAMIN CHARLES (DC, CSCS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:BAKER
Suffix:
Gender:M
Credentials:DC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 FACTORIA BLVD SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-590-9619
Mailing Address - Fax:425-590-9641
Practice Address - Street 1:4122 FACTORIA BLVD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-590-9619
Practice Address - Fax:425-590-9641
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH-60150335111N00000X
WACH60150335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor