Provider Demographics
NPI:1851321723
Name:BARRY, NICOLE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:BARRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MISSION ST
Mailing Address - Street 2:#2
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2433
Mailing Address - Country:US
Mailing Address - Phone:805-201-2909
Mailing Address - Fax:805-201-2931
Practice Address - Street 1:30 W MISSION ST
Practice Address - Street 2:#2
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2433
Practice Address - Country:US
Practice Address - Phone:805-201-2909
Practice Address - Fax:805-201-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV04769Medicare UPIN