Provider Demographics
NPI:1407810104
Name:FEDON, BARRY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:WAYNE
Last Name:FEDON
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 1:391B NAZARETH PIKE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9601
Mailing Address - Country:US
Mailing Address - Phone:610-759-9678
Mailing Address - Fax:610-759-9186
Practice Address - Street 1:391B NAZARETH PIKE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9601
Practice Address - Country:US
Practice Address - Phone:610-759-9678
Practice Address - Fax:610-759-9186
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC4081L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2111376000OtherBLUE CROSS PERSONAL CHOIC
PA562540OtherHIGHMARK BLUE SHIELD
PA2957335OtherAETNA
PA607154OtherUNITED HEALTH CARE
PA02785300OtherCAPITAL BLUE CROSS
PA3998498OtherCIGNA
PA607154OtherUNITED HEALTH CARE
PA02785300OtherCAPITAL BLUE CROSS