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General NPI Number Information
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NPI Number | 1508207358
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Entity Type | Organization
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Legal Business Name | BAKER SPINE AND SPORT INC
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 620 E LAMAR ST
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City | ROYSE CITY
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State | TX
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Zip | 75189-3900
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Country | US
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Telephone | 972-635-9115
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Fax | 972-635-9119
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Provider Business Mailing Address
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Address Line | PO BOX 739
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City | ROYSE CITY
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State | TX
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Zip | 75189-0739
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Country | US
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Telephone | 972-635-9115
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Fax | 972-635-9119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY RAY BAKER
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Credential | D.C.
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Telephone | 972-635-9115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 12082
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License Number State | TX
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