Provider Demographics
NPI:1396226288
Name:RUSSELL E BAKER, DC PC
Entity Type:Organization
Organization Name:RUSSELL E BAKER, DC PC
Other - Org Name:BAKER CHIROPRACTIC INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-989-8111
Mailing Address - Street 1:15901 CENTRAL COMMERCE DR STE 503
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2046
Mailing Address - Country:US
Mailing Address - Phone:512-989-8111
Mailing Address - Fax:512-989-8181
Practice Address - Street 1:15901 CENTRAL COMMERCE DR STE 503
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2046
Practice Address - Country:US
Practice Address - Phone:512-989-8111
Practice Address - Fax:512-989-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty