Provider Demographics
NPI:1750489233
Name:BARRY, EDWIN F (DC)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:F
Last Name:BARRY
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 1:181 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4153
Mailing Address - Country:US
Mailing Address - Phone:856-435-7377
Mailing Address - Fax:856-435-6828
Practice Address - Street 1:181 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4153
Practice Address - Country:US
Practice Address - Phone:856-435-7377
Practice Address - Fax:856-435-6828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC01870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44580Medicare UPIN