Healthcare Provider Details

I. General information

NPI: 1346398088
Provider Name (Legal Business Name): MATTHEW RAY BAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 S MAIN ST STE A
MARYVILLE MO
64468-3624
US

IV. Provider business mailing address

36553 KATYDID RD
BARNARD MO
64423-7204
US

V. Phone/Fax

Practice location:
  • Phone: 660-582-4357
  • Fax: 866-239-7931
Mailing address:
  • Phone: 816-260-4315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002218A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008015698
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: