Provider Demographics
NPI:1235293606
Name:BARTA, JEANNE W (DC)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:W
Last Name:BARTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-3006
Mailing Address - Country:US
Mailing Address - Phone:925-682-4941
Mailing Address - Fax:
Practice Address - Street 1:5011 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3006
Practice Address - Country:US
Practice Address - Phone:925-682-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0169430Medicare PIN
CAT06309Medicare UPIN