Provider Demographics
NPI:1851570287
Name:BAKER CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:BAKER CHIROPRACTIC CENTER PSC
Other - Org Name:CARDINAL CHIROPRACTIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-448-5241
Mailing Address - Street 1:4452 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2866
Mailing Address - Country:US
Mailing Address - Phone:502-448-5241
Mailing Address - Fax:
Practice Address - Street 1:4452 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2866
Practice Address - Country:US
Practice Address - Phone:502-448-5241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200494680AMedicaid
KY85001410Medicaid
KY7607Medicare PIN
KY85001410Medicaid