MEDICARE: MICHAEL WILLIAMS BAKER DC

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	1141203	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1912982927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILLIAMS BAKER DC

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	:	502-448-1555

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	:	502-448-1555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/07/2011

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Directions to “ MICHAEL WILLIAMS BAKER DC” Practice Location

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