Provider Demographics
NPI:1932672466
Name:BAKER, JOSHUA (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
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 1:16310 S LINCOLN HWY STE 128
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-9064
Mailing Address - Country:US
Mailing Address - Phone:815-782-8440
Mailing Address - Fax:815-926-5305
Practice Address - Street 1:16310 S LINCOLN HWY STE 128
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-9064
Practice Address - Country:US
Practice Address - Phone:815-782-8440
Practice Address - Fax:815-926-5305
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
14361443OtherCAQH