Provider Demographics
NPI:1891757852
Name:BARNARD, PHILIP CHARLES (DC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:CHARLES
Last Name:BARNARD
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 1:2440 HWY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7323
Mailing Address - Country:US
Mailing Address - Phone:928-704-2225
Mailing Address - Fax:928-704-0402
Practice Address - Street 1:2440 HWY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7323
Practice Address - Country:US
Practice Address - Phone:928-704-2225
Practice Address - Fax:928-704-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4946A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ225548Medicaid
AZZ83080Medicare PIN
AZ225548Medicaid