Provider Demographics
NPI:1609962208
Name:BARRY, BRIAN A (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
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 1:818 MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4350
Mailing Address - Country:US
Mailing Address - Phone:208-756-1428
Mailing Address - Fax:
Practice Address - Street 1:818 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4350
Practice Address - Country:US
Practice Address - Phone:208-756-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06485111N00000X
MT1171111N00000X
IDCHIA 1282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0253823Medicaid
IAU89424Medicare UPIN
IAI15699Medicare ID - Type Unspecified