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NPI Code Detail

MEDICARE: 27TH AVE MEDICAL PC

MEDICARE: 27TH AVE MEDICAL PC
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
1111N00000XChiropractor1026AZ

General Provider Information

NPI Number : 1558539858
Entity Type Code : Organization
Provider Name (Legal Business Name) : 27TH AVE MEDICAL PC
Provider Business Mailing Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-249-4508
Fax Number : 602-249-1614
Provider Business Practice Location Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-249-4508
Fax Number : 602-249-1614
Authorized Official
Title or Position : OWNER
Name : DR. ROGER H BAKER
Credential : D.C.
Telephone Number : 602-249-4508
Provider Enumeration Date : 02/20/2008
Last Update Date : 06/25/2009

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Directions to “27TH AVE MEDICAL PC ” Practice Location

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