Provider Demographics
NPI:1962666248
Name:SHERWOOD, BARRY G (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:G
Other - Last Name:SHERWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2128 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7311
Mailing Address - Country:US
Mailing Address - Phone:208-249-9629
Mailing Address - Fax:
Practice Address - Street 1:2128 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7311
Practice Address - Country:US
Practice Address - Phone:208-249-9629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor