Provider Demographics
NPI:1184911570
Name:BAKER, MAKENZIE (DC)
Entity type:Individual
Prefix:DR
First Name:MAKENZIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E BEALE ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5833
Mailing Address - Country:US
Mailing Address - Phone:928-681-2300
Mailing Address - Fax:928-681-3330
Practice Address - Street 1:407 E BEALE ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5833
Practice Address - Country:US
Practice Address - Phone:928-681-2300
Practice Address - Fax:928-681-3330
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01425111N00000X
AZ8258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor