Provider Demographics
NPI:1487855656
Name:BARNES FAMILY CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:BARNES FAMILY CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-541-3434
Mailing Address - Street 1:4302 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7169
Mailing Address - Country:US
Mailing Address - Phone:239-541-3434
Mailing Address - Fax:239-541-2555
Practice Address - Street 1:4302 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7169
Practice Address - Country:US
Practice Address - Phone:239-541-3434
Practice Address - Fax:239-541-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381799700Medicaid
FL381799700Medicaid
FL53922ZMedicare PIN