Provider Demographics
NPI:1962512137
Name:BAEK, ALEX S (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:S
Last Name:BAEK
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 1:8727 GRAND OAKS CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3166
Mailing Address - Country:US
Mailing Address - Phone:909-920-5119
Mailing Address - Fax:
Practice Address - Street 1:13801 ROSWELL AVE
Practice Address - Street 2:STE. G
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5466
Practice Address - Country:US
Practice Address - Phone:909-548-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor