Provider Demographics
NPI:1053532705
Name:BAKER, GERALD J (DC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:J
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 1:1060 CHINOE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6589
Mailing Address - Country:US
Mailing Address - Phone:859-335-9355
Mailing Address - Fax:859-335-5765
Practice Address - Street 1:1060 CHINOE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6589
Practice Address - Country:US
Practice Address - Phone:859-335-9355
Practice Address - Fax:859-335-5765
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000016Medicaid
KYU71885Medicare UPIN
KY85000016Medicaid