Provider Demographics
NPI:1801159041
Name:BAKER, BRADLEY RAY (DC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RAY
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:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-0739
Mailing Address - Country:US
Mailing Address - Phone:972-635-9115
Mailing Address - Fax:972-635-9119
Practice Address - Street 1:620 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3900
Practice Address - Country:US
Practice Address - Phone:972-635-9115
Practice Address - Fax:972-635-9119
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor