Provider Demographics
NPI:1912982927
Name:BAKER, MICHAEL WILLIAMS (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILLIAMS
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 1:4452 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2866
Mailing Address - Country:US
Mailing Address - Phone:502-448-5241
Mailing Address - Fax:502-448-1555
Practice Address - Street 1:4452 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2866
Practice Address - Country:US
Practice Address - Phone:502-448-5241
Practice Address - Fax:502-448-1555
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001410Medicaid
KY1141203OtherPASSPORT
KY85001410Medicaid
U83691Medicare UPIN