Provider Demographics
NPI:1598713539
Name:BAKER, SAMUEL STEVEN (DC, FACO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:STEVEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:DC, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 N. CRAYCROFT ROAD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2829
Mailing Address - Country:US
Mailing Address - Phone:520-323-2888
Mailing Address - Fax:520-323-9102
Practice Address - Street 1:2122 N. CRAYCROFT ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2829
Practice Address - Country:US
Practice Address - Phone:520-323-2888
Practice Address - Fax:520-323-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4082111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22956Medicare ID - Type Unspecified