Provider Demographics
NPI:1669400354
Name:BAKER, BRIAN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
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 1:404 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2231
Mailing Address - Country:US
Mailing Address - Phone:860-631-0555
Mailing Address - Fax:203-486-8237
Practice Address - Street 1:404 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2231
Practice Address - Country:US
Practice Address - Phone:860-631-0555
Practice Address - Fax:203-486-8237
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTV07013Medicare UPIN
CT350001456Medicare ID - Type Unspecified