Provider Demographics
NPI:1649466780
Name:SHULAK, BARRY D (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
Last Name:SHULAK
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 1:8225 SW APPLE WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1783
Mailing Address - Country:US
Mailing Address - Phone:503-245-8445
Mailing Address - Fax:503-292-4550
Practice Address - Street 1:1623 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1425
Practice Address - Country:US
Practice Address - Phone:503-313-2576
Practice Address - Fax:503-715-0511
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor