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NPI Code Detail

MEDICARE: DR. GARY WALLACE BAKER D.C., Q.M.E.

MEDICARE: DR. GARY WALLACE BAKER D.C., Q.M.E.
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
1111N00000XChiropractor14305CA

General Provider Information

NPI Number : 1780718254
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY WALLACE BAKER D.C., Q.M.E.
Provider Business Mailing Address
First Line : 234 S PACIFIC COAST HWY
Second Line : SUITE 202
City : REDONDO BEACH
State : CA
Zip : 90277-3383
Country : US
Telephone Number : 310-374-7482
Fax Number :
Provider Business Practice Location Address
First Line : 234 S PACIFIC COAST HWY
Second Line : SUITE 202
City : REDONDO BEACH
State : CA
Zip : 90277-3383
Country : US
Telephone Number : 310-374-7482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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