Provider Demographics
NPI:1336203835
Name:RYAN BAKER, D.C. P.C.
Entity Type:Organization
Organization Name:RYAN BAKER, D.C. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-471-0701
Mailing Address - Street 1:333 SW 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2513
Mailing Address - Country:US
Mailing Address - Phone:541-471-0701
Mailing Address - Fax:541-471-9577
Practice Address - Street 1:333 SW 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2513
Practice Address - Country:US
Practice Address - Phone:541-471-0701
Practice Address - Fax:541-471-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR713657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherTAX ID
OR=========OtherTAX ID