Provider Demographics
NPI:1275656696
Name:CANTY, BARRY ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ROBERT
Last Name:CANTY
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 1:32 W 25TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2265
Mailing Address - Country:US
Mailing Address - Phone:650-349-1516
Mailing Address - Fax:650-349-1099
Practice Address - Street 1:32 W 25TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2265
Practice Address - Country:US
Practice Address - Phone:650-349-1516
Practice Address - Fax:650-349-1099
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor