Provider Demographics
NPI:1609974856
Name:BARKER, JERRY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WAYNE
Last Name:BARKER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 COMMON DR
Mailing Address - Street 2:STE. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5934
Mailing Address - Country:US
Mailing Address - Phone:915-590-9355
Mailing Address - Fax:915-590-9361
Practice Address - Street 1:8001 N MESA ST
Practice Address - Street 2:BLD. E #325
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1736
Practice Address - Country:US
Practice Address - Phone:915-590-9355
Practice Address - Fax:915-590-9361
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6634111N00000X
TX0108948332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605442Medicare ID - Type UnspecifiedPROVIDER NUMBER
TXU61680Medicare UPIN