Provider Demographics
NPI:1134365851
Name:BAKER, TYLER ANSON (DC)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ANSON
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 1:10815 PRAIRIE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4827
Mailing Address - Country:US
Mailing Address - Phone:402-397-1800
Mailing Address - Fax:
Practice Address - Street 1:10815 PRAIRIE BROOK RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4827
Practice Address - Country:US
Practice Address - Phone:402-397-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025728300Medicaid