Provider Demographics
NPI:1124464003
Name:BAIRD, CARL ROBERT (DC, MS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ROBERT
Last Name:BAIRD
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 NE 7TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3996
Mailing Address - Country:US
Mailing Address - Phone:503-724-4706
Mailing Address - Fax:
Practice Address - Street 1:1836 NE 7TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3996
Practice Address - Country:US
Practice Address - Phone:503-724-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5696111NS0005X, 111N00000X
CO0006947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician