Provider Demographics
NPI:1982750550
Name:BAKER, RUSSELL EDWARD (DC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:EDWARD
Last Name:BAKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15901 CENTRAL COMMERCE DR
Mailing Address - Street 2:503
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660
Mailing Address - Country:US
Mailing Address - Phone:512-989-8111
Mailing Address - Fax:512-989-8181
Practice Address - Street 1:15901 CENTRAL COMMERCE
Practice Address - Street 2:503
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660
Practice Address - Country:US
Practice Address - Phone:512-989-8111
Practice Address - Fax:512-989-8181
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
607063OtherBLUE CROSS
607063OtherBLUE CROSS
TX609569Medicare ID - Type Unspecified