Provider Demographics
NPI:1679576490
Name:MONBARREN, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MONBARREN
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 1:616 INDIAN TRAIL RD S
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-9680
Mailing Address - Country:US
Mailing Address - Phone:704-821-5000
Mailing Address - Fax:855-884-7853
Practice Address - Street 1:616 INDIAN TRAIL RD S
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-9680
Practice Address - Country:US
Practice Address - Phone:704-821-6000
Practice Address - Fax:855-884-7853
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2457840Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NCU35813Medicare UPIN