MEDICARE: BAEK'S CHIROPRACTIC HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	DC27581	CA

General Provider Information

NPI Number	:	1538417597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAEK'S CHIROPRACTIC HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	13801 ROSWELL AVE
Second Line	:	STE. G
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-548-6868
Fax Number	:	909-548-6868

Provider Business Practice Location Address
First Line	:	13801 ROSWELL AVE
Second Line	:	STE. G
City	:	CHINO
State	:	CA
Zip	:	91710-5466
Country	:	US
Telephone Number	:	909-548-6868
Fax Number	:	909-548-6868

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALEX BAEK
Credential	:	D.C.
Telephone Number	:	909-548-6868

Provider Enumeration Date	:	08/23/2012
Last Update Date	:	08/23/2012

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