Provider Demographics
NPI:1124043922
Name:ROBERT O. BARNUM DC PA
Entity Type:Organization
Organization Name:ROBERT O. BARNUM DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:BARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-726-3324
Mailing Address - Street 1:202 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4305
Mailing Address - Country:US
Mailing Address - Phone:252-726-3324
Mailing Address - Fax:252-726-9551
Practice Address - Street 1:202 PENNY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4305
Practice Address - Country:US
Practice Address - Phone:252-726-3324
Practice Address - Fax:252-726-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890253YMedicaid
NC0253YOtherBCBS
NC890253YMedicaid