Provider Demographics
NPI:1609079706
Name:BAKER, DENNIS EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
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 1:4543 DULIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2120
Mailing Address - Country:US
Mailing Address - Phone:636-671-5440
Mailing Address - Fax:636-671-5512
Practice Address - Street 1:4543 DULIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-2120
Practice Address - Country:US
Practice Address - Phone:636-671-5440
Practice Address - Fax:636-671-5512
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004157111N00000X
MT942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30749Medicare ID - Type UnspecifiedMO MEDICARE PART B