Provider Demographics
NPI:1700818796
Name:BAKER, RICK ALLAN (DC)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:ALLAN
Last Name:BAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1309 PONDEROSA DRIVE 7B CHIROPRACTIC
Mailing Address - Street 2:STE 202
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-597-7863
Mailing Address - Fax:208-597-7863
Practice Address - Street 1:1309 PONDEROSA DRIVE 7B CHIROPRACTIC
Practice Address - Street 2:STE 202
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-597-7863
Practice Address - Fax:208-597-7863
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA969111N00000X
ID969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806495700Medicaid
1674882Medicare ID - Type Unspecified