Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH00001895 | WA |
NPI | 1003959453 |
---|---|
Provider Name | Carl Randolph Baze |
First Address | Renton, WA 98057 |
Second Address | Renton, WA 98057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 24/08/2010 |