Healthcare Provider Details

I. General information

NPI: 1962798777
Provider Name (Legal Business Name): BAKER CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N MAIN ST
STURGIS KY
42459-1630
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: 270-333-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5292
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5293
License Number StateKY

VIII. Authorized Official

Name: DR. KATHRYN ELIZABETH BAKER
Title or Position: MANAGER
Credential: D.C.
Phone: 270-333-4641