Provider Demographics
NPI:1669461885
Name:TRIESTMAN, BARRY MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MARK
Last Name:TRIESTMAN
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 1:11464 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-1716
Mailing Address - Country:US
Mailing Address - Phone:530-550-1688
Mailing Address - Fax:530-550-1622
Practice Address - Street 1:11464 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-1716
Practice Address - Country:US
Practice Address - Phone:530-412-0072
Practice Address - Fax:530-550-1622
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25940111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition