Healthcare Provider Details

I. General information

NPI: 1679523856
Provider Name (Legal Business Name): NATHALIE D BAKER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 DIABLO DR
TRAVIS AFB CA
94535-1156
US

IV. Provider business mailing address

406 DIABLO DR
TRAVIS AFB CA
94535-1156
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1413
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: