Provider Demographics
NPI:1932522182
Name:DRBRYANBAKER.COM LLC
Entity Type:Organization
Organization Name:DRBRYANBAKER.COM LLC
Other - Org Name:SPINE HAND AND FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-252-1587
Mailing Address - Street 1:13723 E 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3321
Mailing Address - Country:US
Mailing Address - Phone:816-252-1587
Mailing Address - Fax:
Practice Address - Street 1:13723 E 39TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3321
Practice Address - Country:US
Practice Address - Phone:816-252-1587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center