MEDICARE: DR. ALEX S. BAEK D.C.

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	DC27581	CA

General Provider Information

NPI Number	:	1962512137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX S. BAEK D.C.

Provider Business Mailing Address
First Line	:	8727 GRAND OAKS CT
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3166
Country	:	US
Telephone Number	:	909-920-5119
Fax Number	:

Provider Business Practice Location Address
First Line	:	13801 ROSWELL AVE
Second Line	:	STE. G
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-548-6868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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