Provider Demographics
NPI:1053656819
Name:BARKSDALE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BARKSDALE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-232-1901
Mailing Address - Street 1:2955 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3211
Mailing Address - Country:US
Mailing Address - Phone:812-232-1901
Mailing Address - Fax:812-234-5103
Practice Address - Street 1:2955 S 13TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3211
Practice Address - Country:US
Practice Address - Phone:812-232-1901
Practice Address - Fax:812-234-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001299A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100155370AMedicaid
INU17408Medicare UPIN