Provider Demographics
NPI:1518046077
Name:BARR, STEPHEN ELDRIDGE (LAC, DIPLAC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ELDRIDGE
Last Name:BARR
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7696
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-7696
Mailing Address - Country:US
Mailing Address - Phone:530-583-9407
Mailing Address - Fax:530-583-0543
Practice Address - Street 1:505 WEST LAKE BLVD.
Practice Address - Street 2:SUITE 3
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-583-9407
Practice Address - Fax:530-583-0543
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 1139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist