Provider Demographics
NPI:1417412966
Name:BARRY, IAN RAPHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:RAPHAEL
Last Name:BARRY
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 1:532 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1437
Mailing Address - Country:US
Mailing Address - Phone:973-985-6637
Mailing Address - Fax:
Practice Address - Street 1:532 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-1437
Practice Address - Country:US
Practice Address - Phone:973-467-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00759500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor