Provider Demographics
NPI:1215060728
Name:BAK, JENNIFER J (DC, PC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:BAK
Suffix:
Gender:F
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W WATER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2907
Mailing Address - Country:US
Mailing Address - Phone:781-224-0010
Mailing Address - Fax:781-224-0147
Practice Address - Street 1:1 W WATER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2907
Practice Address - Country:US
Practice Address - Phone:781-224-0010
Practice Address - Fax:781-224-0147
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY74422Medicare UPIN
MAY45690Medicare ID - Type Unspecified