Provider Demographics
NPI:1760615868
Name:BARRACK, STEVEN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
Last Name:BARRACK
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 1:44751 VILLAGE CT # 300
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3815
Mailing Address - Country:US
Mailing Address - Phone:760-332-9775
Mailing Address - Fax:
Practice Address - Street 1:44751 VILLAGE CT # 300
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3815
Practice Address - Country:US
Practice Address - Phone:760-332-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA016253111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner