Provider Demographics
NPI:1689775181
Name:AMESBARRY CHIROPRACTIC PSC
Entity Type:Organization
Organization Name:AMESBARRY CHIROPRACTIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-894-9888
Mailing Address - Street 1:2500 COUNTY ROAD 42 W STE 4
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6945
Mailing Address - Country:US
Mailing Address - Phone:952-894-9888
Mailing Address - Fax:952-894-2154
Practice Address - Street 1:2500 COUNTY ROAD 42 W STE 4
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6945
Practice Address - Country:US
Practice Address - Phone:952-894-9888
Practice Address - Fax:952-894-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002323111N00000X
MN002869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN23907HUOtherBCBS
MN718315100Medicaid
MN718315100Medicaid
MN350002027Medicare ID - Type Unspecified
MN23907HUOtherBCBS
MN350002026Medicare ID - Type Unspecified