Provider Demographics
NPI:1598124422
Name:BAKER, ANEESAH NICHOL (DC)
Entity Type:Individual
Prefix:DR
First Name:ANEESAH
Middle Name:NICHOL
Last Name:BAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 REED CANAL RD
Mailing Address - Street 2:#4
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8000
Mailing Address - Country:US
Mailing Address - Phone:407-574-8542
Mailing Address - Fax:407-442-2071
Practice Address - Street 1:927 S GOLDWYN AVE
Practice Address - Street 2:SUITE #220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-4324
Practice Address - Country:US
Practice Address - Phone:407-574-8542
Practice Address - Fax:407-442-2071
Is Sole Proprietor?:No
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor