Provider Demographics
NPI:1083762744
Name:BICKERTON, R BARNABAS (DC)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:BARNABAS
Last Name:BICKERTON
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 1:9819 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1806
Mailing Address - Country:US
Mailing Address - Phone:623-975-3373
Mailing Address - Fax:
Practice Address - Street 1:11132 W CALIFORNIA AVE STE B
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1201
Practice Address - Country:US
Practice Address - Phone:623-388-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor