MEDICARE: KELLY S BAKER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2006022901	MO

General Provider Information

NPI Number	:	1386191385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLY S BAKER PC

Provider Business Mailing Address
First Line	:	5140 NE ANTIOCH RD STE A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2523
Country	:	US
Telephone Number	:	816-452-0500
Fax Number	:	816-452-0565

Provider Business Practice Location Address
First Line	:	5140 NE ANTIOCH RD STE A
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2523
Country	:	US
Telephone Number	:	816-452-0500
Fax Number	:	816-452-0565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KELLY STEVEN BAKER
Credential	:	D.C
Telephone Number	:	816-452-0500

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/08/2016

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