Healthcare Provider Details

I. General information

NPI: 1962512137
Provider Name (Legal Business Name): ALEX S. BAEK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 ROSWELL AVE STE. G
CHINO CA
91710-5466
US

IV. Provider business mailing address

8727 GRAND OAKS CT
RANCHO CUCAMONGA CA
91730-3166
US

V. Phone/Fax

Practice location:
  • Phone: 909-548-6868
  • Fax:
Mailing address:
  • Phone: 909-920-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: