Provider Demographics
NPI:1790069268
Name:BAKER, BRIAN E (MACOM, DIPL AC, LAC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:MACOM, DIPL AC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 NE CORNELL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5412
Mailing Address - Country:US
Mailing Address - Phone:503-516-5703
Mailing Address - Fax:
Practice Address - Street 1:6125 NE CORNELL RD
Practice Address - Street 2:SUITE 230
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5412
Practice Address - Country:US
Practice Address - Phone:503-516-5703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC154147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist