Provider Demographics
NPI:1083700983
Name:COLE, BARRY L (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:COLE
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 1:417 TROY AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3947
Mailing Address - Country:US
Mailing Address - Phone:731-285-2696
Mailing Address - Fax:731-285-2701
Practice Address - Street 1:417 TROY AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3947
Practice Address - Country:US
Practice Address - Phone:731-285-2696
Practice Address - Fax:731-285-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006358OtherBCBS PROVIDER NUMBER
TN2006358OtherBCBS PROVIDER NUMBER
TNT74776Medicare UPIN