Healthcare Provider Details

I. General information

NPI: 1538417597
Provider Name (Legal Business Name): BAEK'S CHIROPRACTIC HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/23/2012
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC27581
License Number StateCA

VIII. Authorized Official

Name: DR. ALEX BAEK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 909-548-6868