Provider Demographics
NPI:1366563934
Name:STEVEN BACA D.C. P.C.
Entity type:Organization
Organization Name:STEVEN BACA D.C. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-882-9222
Mailing Address - Street 1:2918 E BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4016
Mailing Address - Country:US
Mailing Address - Phone:417-882-9222
Mailing Address - Fax:417-882-9223
Practice Address - Street 1:2918 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4016
Practice Address - Country:US
Practice Address - Phone:417-882-9222
Practice Address - Fax:417-882-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000031818Medicare ID - Type Unspecified
MOU80971Medicare UPIN