Provider Demographics
NPI:1336210491
Name:BAKER, CHARLES AUGUSTUS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:AUGUSTUS
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7855 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2462
Mailing Address - Country:US
Mailing Address - Phone:303-424-9184
Mailing Address - Fax:303-424-0486
Practice Address - Street 1:7855 RALSTON RD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2462
Practice Address - Country:US
Practice Address - Phone:303-424-9184
Practice Address - Fax:303-424-0486
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1015-3Medicare ID - Type Unspecified