Provider Demographics
NPI:1063509693
Name:BARAKAT, TRISHA DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:DAWN
Last Name:BARAKAT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 72ND ST
Mailing Address - Street 2:SUITE P
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-270-9696
Mailing Address - Fax:515-270-1348
Practice Address - Street 1:2600 72ND ST
Practice Address - Street 2:SUITE P
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-270-9696
Practice Address - Fax:515-270-1348
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0148387Medicaid
IA665165OtherACN
IA56637OtherBCBS
IA56637Medicare ID - Type Unspecified