Provider Demographics
NPI:1740361674
Name:BAKER, LESLIE PAIGE (DC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:PAIGE
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 1:171 COLLEGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6211
Mailing Address - Country:US
Mailing Address - Phone:817-599-0061
Mailing Address - Fax:817-599-0062
Practice Address - Street 1:171 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6211
Practice Address - Country:US
Practice Address - Phone:817-599-0061
Practice Address - Fax:817-599-0062
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650283OtherUNITED
TX8M2030OtherBCBS
TX8D2735Medicare ID - Type Unspecified
TX650283OtherUNITED