Provider Demographics
NPI:1952571010
Name:KELLY BAKER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KELLY BAKER CHIROPRACTIC PC
Other - Org Name:SWICKARD CHIROPRACTIC CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-452-0500
Mailing Address - Street 1:2518 NE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-0000
Mailing Address - Country:US
Mailing Address - Phone:816-452-0500
Mailing Address - Fax:816-452-0565
Practice Address - Street 1:2518 NE 43RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-0000
Practice Address - Country:US
Practice Address - Phone:816-452-0500
Practice Address - Fax:816-452-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1049Medicare PIN