Provider Demographics
NPI:1114113545
Name:FREDERICK A BARKS, JR
Entity Type:Organization
Organization Name:FREDERICK A BARKS, JR
Other - Org Name:PUTNAM CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:860-928-7729
Mailing Address - Street 1:245 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1621
Mailing Address - Country:US
Mailing Address - Phone:860-928-7729
Mailing Address - Fax:860-928-0593
Practice Address - Street 1:245 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1621
Practice Address - Country:US
Practice Address - Phone:860-928-7729
Practice Address - Fax:860-928-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001391111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3823400OtherAETNA
CTC03295OtherMEDICARE GROUP ID
CT050001391CT02OtherBCBS OF CT
CT2V5130OtherHEALTHNET
RI412398OtherBLUE CHIP OF RI
CT010391OtherCONNECTICARE
MAAA32943OtherHARVARD PILGRIM
CTP00217640OtherMEDICARE ID - RAILROAD ME
CT1030756OtherASHN
CTP2686322OtherOXFORD
RI29336-1OtherBCBS OF RI
CT4404611OtherUNITED HEALTHCARE
CT06985925002OtherCIGNA
RI29336-1OtherBCBS OF RI
CTP00217640OtherMEDICARE ID - RAILROAD ME
CTC03295OtherMEDICARE GROUP ID