Provider Demographics
NPI:1134150626
Name:BAKER, TERRY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:LEE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:49220 ROAD 426
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9775
Mailing Address - Country:US
Mailing Address - Phone:559-683-3770
Mailing Address - Fax:559-683-3770
Practice Address - Street 1:49220 ROAD 426
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9775
Practice Address - Country:US
Practice Address - Phone:559-683-3770
Practice Address - Fax:559-683-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0111750Medicare ID - Type Unspecified
T04217Medicare UPIN