Provider Demographics
NPI:1356485858
Name:PEDICORD, BARRY SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:SCOTT
Last Name:PEDICORD
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 1:3625 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-2438
Mailing Address - Country:US
Mailing Address - Phone:937-252-1671
Mailing Address - Fax:937-252-7717
Practice Address - Street 1:3625 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-2438
Practice Address - Country:US
Practice Address - Phone:937-252-1671
Practice Address - Fax:937-252-7717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPE0384731Medicare ID - Type Unspecified
OHT46315Medicare UPIN