Provider Demographics
NPI:1134239718
Name:BARNETT, ROBERT CHARLES (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:BARNETT
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 1:1663 ROUTE 12
Mailing Address - Street 2:P.O. BOX 394
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1500
Mailing Address - Country:US
Mailing Address - Phone:860-464-0036
Mailing Address - Fax:860-415-0201
Practice Address - Street 1:1663 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1500
Practice Address - Country:US
Practice Address - Phone:860-464-0036
Practice Address - Fax:860-415-0201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000834111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO2845Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER