Provider Demographics
NPI:1417957994
Name:BAKER, GALEN J (DC)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:J
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 1:3205 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4332
Mailing Address - Country:US
Mailing Address - Phone:608-249-7657
Mailing Address - Fax:
Practice Address - Street 1:2702 MONROE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1888
Practice Address - Country:US
Practice Address - Phone:608-231-9152
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:2005-07-28
Deactivation Code:
Reactivation Date:2005-08-22
Provider Licenses
StateLicense IDTaxonomies
WI2270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38835200Medicaid
WIT61399Medicare UPIN