Provider Demographics
NPI:1841473881
Name:BAKER FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:BAKER FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-859-5055
Mailing Address - Street 1:1053 S TRADE ST
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-3790
Mailing Address - Country:US
Mailing Address - Phone:828-859-5055
Mailing Address - Fax:828-859-5042
Practice Address - Street 1:1053 S TRADE ST
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-3790
Practice Address - Country:US
Practice Address - Phone:828-859-5055
Practice Address - Fax:828-859-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2244111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890821YMedicaid
NC0821YOtherBLUE CROSS BLUE SHIELD NORTH CAROLINA
NC890821YMedicaid