Healthcare Provider Details

I. General information

NPI: 1982996609
Provider Name (Legal Business Name): TRAVIS A BAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 N 169TH PLZ SUITE B
OMAHA NE
68118-2846
US

IV. Provider business mailing address

1817 N 169TH PLZ STE B
OMAHA NE
68118-2831
US

V. Phone/Fax

Practice location:
  • Phone: 402-932-8108
  • Fax: 402-932-8109
Mailing address:
  • Phone: 402-881-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1683
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: