Provider Demographics
NPI:1710920004
Name:BARKER, GARY TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:TODD
Last Name:BARKER
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-0247
Mailing Address - Country:US
Mailing Address - Phone:615-323-0130
Mailing Address - Fax:615-323-0130
Practice Address - Street 1:826 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1622
Practice Address - Country:US
Practice Address - Phone:615-323-0130
Practice Address - Fax:615-323-0136
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4048097OtherBCBS
TN2323896OtherCIGNA
TNU71623Medicare UPIN
TN4048097OtherBCBS