Provider Demographics
NPI:1972680973
Name:BAKER CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:BAKER CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-263-2247
Mailing Address - Street 1:102 S EUCLID AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-4912
Mailing Address - Country:US
Mailing Address - Phone:208-263-2247
Mailing Address - Fax:208-263-2268
Practice Address - Street 1:102 S EUCLID AVE
Practice Address - Street 2:STE 109
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-4912
Practice Address - Country:US
Practice Address - Phone:208-263-2247
Practice Address - Fax:208-263-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806495100Medicaid
U88333Medicare UPIN
ID806495100Medicaid