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General NPI Number Information
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NPI Number | 1609944370
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Entity Type | Organization
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Legal Business Name | JENNIFER J BAK DC PC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 07/30/2013
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Provider Practice Location Address
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Address Line | ONE WEST WATER ST STE 207
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City | WAKEFIELD
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State | MA
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Zip | 01880
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Country | US
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Telephone | 781-224-0010
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Fax | 781-224-0147
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Provider Business Mailing Address
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Address Line | ONE WEST WATER STREET SUITE 207
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City | WAKEFIELD
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State | MA
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Zip | 01880
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Country | US
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Telephone | 781-224-0010
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Fax | 781-224-0147
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. JENNIFER J BAK
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Credential | DC
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Telephone | 781-224-0010
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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 | 2125
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License Number State | MA
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Legacy Identifiers
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Identifier #1
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Identifier Code | Y39752
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | GROUP BCBS MA
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Identifier #2
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Identifier Code | Y36545
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | BCBS MA
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | Y36545
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | BCBS MA
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Identifier #2
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Identifier Code | Y39752
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | GROUP BCBS MA
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