Provider Demographics
NPI:1154510451
Name:BARR FAMILY CHIROPRACTIC & SPORTS CLINIC
Entity Type:Organization
Organization Name:BARR FAMILY CHIROPRACTIC & SPORTS CLINIC
Other - Org Name:BARR FAMILY CHIROPRACTIC & SPORTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-429-2279
Mailing Address - Street 1:4719 BANNING AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3217
Mailing Address - Country:US
Mailing Address - Phone:651-429-2279
Mailing Address - Fax:651-429-2361
Practice Address - Street 1:4719 BANNING AVE
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3217
Practice Address - Country:US
Practice Address - Phone:651-429-2279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2310111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03521OtherMEDICARE GROUP NUMBER
MN373R0CAOtherBLUE CROSS BLUE SHIELD GROUP NUMBER
MN373R0CAOtherBLUE CROSS BLUE SHIELD GROUP NUMBER