Provider Demographics
NPI:1659831048
Name:POWDERLY, BARRY GILMOUR (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:GILMOUR
Last Name:POWDERLY
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 1:1315 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1757
Mailing Address - Country:US
Mailing Address - Phone:717-745-8436
Mailing Address - Fax:
Practice Address - Street 1:1315 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1757
Practice Address - Country:US
Practice Address - Phone:717-652-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor