Provider Demographics
NPI:1457421679
Name:BAARS, JOHN (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BAARS
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 1:19900 BEACH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3762
Mailing Address - Country:US
Mailing Address - Phone:714-965-9577
Mailing Address - Fax:714-965-9580
Practice Address - Street 1:19900 BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3762
Practice Address - Country:US
Practice Address - Phone:714-965-9577
Practice Address - Fax:714-965-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33-0711373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
33-0711373OtherTAX ID #
CADC 15122OtherDC #
T17977Medicare UPIN