Healthcare Provider Details

I. General information

NPI: 1316217524
Provider Name (Legal Business Name): SANDY MARIE BAIRD D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 GRAND AVE #5
OAKLAND CA
94610-2013
US

IV. Provider business mailing address

3409 GRAND AVE #5
OAKLAND CA
94610-2013
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-2342
  • Fax: 510-465-2342
Mailing address:
  • Phone: 510-465-2342
  • Fax: 510-465-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number32125
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCA32125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: