Provider Demographics
NPI:1215100748
Name:BAEK CHIROPRACTIC-ACUPUNCTURE, INC
Entity type:Organization
Organization Name:BAEK CHIROPRACTIC-ACUPUNCTURE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:SUNGHEE
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:714-530-7001
Mailing Address - Street 1:9681 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 101-102
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1541
Mailing Address - Country:US
Mailing Address - Phone:714-530-7001
Mailing Address - Fax:714-530-7261
Practice Address - Street 1:9681 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 101-102
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1541
Practice Address - Country:US
Practice Address - Phone:714-530-7001
Practice Address - Fax:714-530-7261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22627111N00000X
CAAC14975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52493Medicare UPIN