Provider Demographics
NPI:1558784447
Name:BARR FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BARR FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:KENTON
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-462-9448
Mailing Address - Street 1:1252 AIRPORT PARK BLVD STE C5
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5979
Mailing Address - Country:US
Mailing Address - Phone:707-462-9448
Mailing Address - Fax:707-462-9456
Practice Address - Street 1:1252 AIRPORT PARK BLVD STE C5
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5979
Practice Address - Country:US
Practice Address - Phone:707-462-9448
Practice Address - Fax:707-462-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BT601ZMedicare PIN