Provider Demographics
NPI:1730127291
Name:BARNES, ALAN (DC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BARNES
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 1:10062 W FAIRVIEW AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8120
Mailing Address - Country:US
Mailing Address - Phone:208-856-0048
Mailing Address - Fax:877-991-7410
Practice Address - Street 1:10062 W FAIRVIEW AVE STE 110
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8120
Practice Address - Country:US
Practice Address - Phone:208-856-0048
Practice Address - Fax:877-991-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHAI1121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDV07425Medicare UPIN
ID1670268Medicare ID - Type Unspecified