MEDICARE: BAKER CHIROPRACTIC CENTER PSC

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	111N00000X	Chiropractor	4621	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851570287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKER CHIROPRACTIC CENTER PSC

Provider Business Mailing Address
First Line	:	4452 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-2866
Country	:	US
Telephone Number	:	502-448-5241
Fax Number	:

Provider Business Practice Location Address
First Line	:	4452 DIXIE HWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40216-2866
Country	:	US
Telephone Number	:	502-448-5241
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PRESIDENT
Name	:	MICHAEL WILLIAMS BAKER
Credential	:
Telephone Number	:	502-448-5241

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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