Provider Demographics
NPI:1720527039
Name:BARRERA, SERGIO ANTONIO (DC)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:ANTONIO
Last Name:BARRERA
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 1:11830 KERR PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1226
Mailing Address - Country:US
Mailing Address - Phone:503-964-4212
Mailing Address - Fax:503-926-9142
Practice Address - Street 1:11830 KERR PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-1226
Practice Address - Country:US
Practice Address - Phone:503-964-4212
Practice Address - Fax:503-926-9142
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor