Provider Demographics
NPI:1609944370
Name:JENNIFER J BAK DC PC
Entity Type:Organization
Organization Name:JENNIFER J BAK DC PC
Other - Org Name:BAK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-224-0010
Mailing Address - Street 1:ONE WEST WATER STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-224-0010
Mailing Address - Fax:781-224-0147
Practice Address - Street 1:ONE WEST WATER ST
Practice Address - Street 2:STE 207
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-224-0010
Practice Address - Fax:781-224-0147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER J BAK DC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-01
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y39752OtherGROUP BCBS MA
Y36545OtherBCBS MA
Y36545OtherBCBS MA
Y45232Medicare ID - Type Unspecified