Provider Demographics
NPI:1568508620
Name:BAKER, PAUL D (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
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 1:204 ARKANSAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1904
Mailing Address - Country:US
Mailing Address - Phone:870-774-3819
Mailing Address - Fax:870-772-4531
Practice Address - Street 1:204 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1904
Practice Address - Country:US
Practice Address - Phone:870-774-3819
Practice Address - Fax:870-772-4531
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U075OtherBCBS PROVIDER NUMBER
AR5U075Medicare ID - Type UnspecifiedPROVIDER NUMBER
AR5U075OtherBCBS PROVIDER NUMBER