Provider Demographics
NPI:1508207358
Name:BAKER SPINE AND SPORT INC
Entity Type:Organization
Organization Name:BAKER SPINE AND SPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-635-9115
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-0739
Mailing Address - Country:US
Mailing Address - Phone:972-635-9115
Mailing Address - Fax:972-635-9119
Practice Address - Street 1:620 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3900
Practice Address - Country:US
Practice Address - Phone:972-635-9115
Practice Address - Fax:972-635-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty