Provider Demographics
NPI:1972665180
Name:BARNICK, BROCK M (DC)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:M
Last Name:BARNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14575 BEL RED RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3908
Mailing Address - Country:US
Mailing Address - Phone:425-641-8052
Mailing Address - Fax:425-641-8053
Practice Address - Street 1:14575 BEL RED RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3908
Practice Address - Country:US
Practice Address - Phone:425-641-8052
Practice Address - Fax:425-641-8053
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WACH00034833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV08673Medicare UPIN