Provider Demographics
NPI:1851337075
Name:SUTPHIN, BARRY WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:WILLIAM
Last Name:SUTPHIN
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 1:10940 STATE R OAD 70 EAST,
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-758-4055
Mailing Address - Fax:
Practice Address - Street 1:10940 STATE R OAD 70 EAST,
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-758-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381470000Medicaid
FL55515OtherBCBS
FL357959OtherWELLCARE
FL381470000Medicaid
FLU76653Medicare UPIN