Healthcare Provider Details

I. General information

NPI: 1508036625
Provider Name (Legal Business Name): BAEKS CHIROPRACTIC HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 ROSWELL AVE SUITE G
CHINO CA
91710-5466
US

IV. Provider business mailing address

13801 ROSWELL AVE SUITE G
CHINO CA
91710-5466
US

V. Phone/Fax

Practice location:
  • Phone: 909-548-6868
  • Fax: 909-548-6855
Mailing address:
  • Phone: 909-548-6868
  • Fax: 909-548-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9447
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC27581
License Number StateCA

VIII. Authorized Official

Name: DR. ALEX S BAEK
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 909-548-6868