Provider Demographics
NPI:1770178196
Name:BACA, WILLIAM F (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:BACA
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 1:13513 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:SOLOMONS
Mailing Address - State:MD
Mailing Address - Zip Code:20688-4008
Mailing Address - Country:US
Mailing Address - Phone:301-247-4723
Mailing Address - Fax:
Practice Address - Street 1:13513 OSPREY LN
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-4008
Practice Address - Country:US
Practice Address - Phone:301-247-4723
Practice Address - Fax:240-794-2326
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB-832111N00000X
MDS04093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty