Provider Demographics
NPI:1790815470
Name:BARNES FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BARNES FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-346-7810
Mailing Address - Street 1:328 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1608
Mailing Address - Country:US
Mailing Address - Phone:719-346-7810
Mailing Address - Fax:719-346-7808
Practice Address - Street 1:328 14TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1608
Practice Address - Country:US
Practice Address - Phone:719-346-7810
Practice Address - Fax:719-346-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO5306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO665245OtherANTHEM BLUE CROSS BLUE SH
CO665245OtherANTHEM BLUE CROSS BLUE SH
C502648Medicare PIN