Healthcare Provider Details

I. General information

NPI: 1316230089
Provider Name (Legal Business Name): KATHRYN ELIZABETH BAKER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MAIN ST
STURGIS KY
42459
US

IV. Provider business mailing address

412 N MAIN ST
STURGIS KY
42459-1630
US

V. Phone/Fax

Practice location:
  • Phone: 270-333-4641
  • Fax: 270-333-4641
Mailing address:
  • Phone: 270-333-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5293
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: