Provider Demographics
NPI:1346398088
Name:BAKER, MATTHEW RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAY
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 1:36553 KATYDID RD
Mailing Address - Street 2:
Mailing Address - City:BARNARD
Mailing Address - State:MO
Mailing Address - Zip Code:64423-7204
Mailing Address - Country:US
Mailing Address - Phone:816-260-4315
Mailing Address - Fax:
Practice Address - Street 1:2408 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-3624
Practice Address - Country:US
Practice Address - Phone:660-582-4357
Practice Address - Fax:866-239-7931
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002218A111N00000X
MO2008015698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor