Healthcare Provider Details

I. General information

NPI: 1568617686
Provider Name (Legal Business Name): BAKER CHIROPRACTIC & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
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

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

V. Phone/Fax

Practice location:
  • Phone: 660-582-4357
  • Fax: 866-239-7931
Mailing address:
  • Phone: 660-582-4357
  • Fax: 866-236-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2008015698
License Number StateMO

VIII. Authorized Official

Name: DR. MATTHEW RAY BAKER
Title or Position: CHIROPRACTOR/MEMBER
Credential: D.C.
Phone: 660-582-4357