Provider Demographics
NPI:1083990196
Name:BAAR, BRIAN RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RICHARD
Last Name:BAAR
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 1:955 LANE AVE
Mailing Address - Street 2:200
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4525
Mailing Address - Country:US
Mailing Address - Phone:619-500-4615
Mailing Address - Fax:619-414-1387
Practice Address - Street 1:2859 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1292
Practice Address - Country:US
Practice Address - Phone:619-500-4615
Practice Address - Fax:619-414-1387
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFV799AMedicare PIN