Provider Demographics
NPI:1346346798
Name:BARR, JAMES T (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:BARR
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:651-429-2361
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2177-012111N00000X
MN2310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI24549OtherSECURITY HEALTH PLAN
WI38797400Medicaid
4404853OtherMEDICA
CJ7409OtherRAILROAD MEDICARE GROUP
WI350022884OtherRAILROAD MEDICARE
MN3AN69BAOtherBCBS MN
P00775087OtherRAILROAD MEDICARE
CC1784AOtherCHIROCARE
P00775087OtherRAILROAD MEDICARE
WI000270180Medicare ID - Type Unspecified
WI38797400Medicaid