Healthcare Provider Details

I. General information

NPI: 1831393081
Provider Name (Legal Business Name): BAKER CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S BARRINGTON AVE STE. 107
LOS ANGELES CA
90025-5363
US

IV. Provider business mailing address

2001 S BARRINGTON AVE STE. 107
LOS ANGELES CA
90025-5363
US

V. Phone/Fax

Practice location:
  • Phone: 310-575-5535
  • Fax: 310-575-5536
Mailing address:
  • Phone: 310-575-5535
  • Fax: 310-575-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC22219
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15475
License Number StateCA

VIII. Authorized Official

Name: DR. MARYANN YUHAS BAKER
Title or Position: OWNER - CLINIC DIRECTOR
Credential: D.C.
Phone: 310-575-5535