Provider Demographics
NPI:1033455548
Name:BARRIENTOS-LOPEZ, JORGE ANTONIO (DC)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:BARRIENTOS-LOPEZ
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 1:3808 TIETON DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3691
Mailing Address - Country:US
Mailing Address - Phone:509-901-9698
Mailing Address - Fax:509-972-0980
Practice Address - Street 1:3808 TIETON DR
Practice Address - Street 2:SUITE #1
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3691
Practice Address - Country:US
Practice Address - Phone:509-901-9698
Practice Address - Fax:509-972-0980
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60325178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor