Provider Demographics
NPI:1467550640
Name:BAKER, COLIN PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:PETER
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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:IL
Mailing Address - Zip Code:61310-0145
Mailing Address - Country:US
Mailing Address - Phone:815-857-2458
Mailing Address - Fax:815-857-2749
Practice Address - Street 1:305 JOE DR E
Practice Address - Street 2:STE110
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310-9492
Practice Address - Country:US
Practice Address - Phone:815-857-2458
Practice Address - Fax:815-857-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1261Medicare PIN