=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962796250
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT WESLEY BAKER L.AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2011
-----------------------------------------------------
Last Update Date | 06/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20307 VIKING AVE NW STE 202
-----------------------------------------------------
City | POULSBO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98370-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-379-6798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 843 TAYLOR ST
-----------------------------------------------------
City | PORT TOWNSEND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98368-5531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-697-6195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 60137267
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------