Provider Demographics
NPI:1902175326
Name:BAKER, CORY ADAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:ADAM
Last Name:BAKER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 S 232ND ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3166
Mailing Address - Country:US
Mailing Address - Phone:206-380-5495
Mailing Address - Fax:888-295-2604
Practice Address - Street 1:9421 S 232ND ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-3166
Practice Address - Country:US
Practice Address - Phone:206-380-5495
Practice Address - Fax:888-295-2604
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60129464171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist