Provider Demographics
NPI:1922568310
Name:BARNESS, BRENT (LAC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:BARNESS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1836
Mailing Address - Country:US
Mailing Address - Phone:563-275-2330
Mailing Address - Fax:
Practice Address - Street 1:408 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1836
Practice Address - Country:US
Practice Address - Phone:563-275-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA99171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty