Provider Demographics
NPI:1063705838
Name:BAKER, JEREMY R (DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:BAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N MAIN ST
Mailing Address - Street 2:PO BOX 124
Mailing Address - City:STURGIS
Mailing Address - State:KY
Mailing Address - Zip Code:42459-1630
Mailing Address - Country:US
Mailing Address - Phone:270-333-4641
Mailing Address - Fax:270-333-4641
Practice Address - Street 1:412 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:KY
Practice Address - Zip Code:42459-1630
Practice Address - Country:US
Practice Address - Phone:270-333-4641
Practice Address - Fax:270-333-4641
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor