Provider Demographics
NPI:1841369238
Name:BARNETT, MICHAEL DERRELL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DERRELL
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 1:2849 MORRISS RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3662
Mailing Address - Country:US
Mailing Address - Phone:972-956-9887
Mailing Address - Fax:888-922-3397
Practice Address - Street 1:2849 MORRISS RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3662
Practice Address - Country:US
Practice Address - Phone:972-956-9887
Practice Address - Fax:888-922-3397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5260111N00000X
TX8558111NI0013X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7294356OtherAETNA
TX609381Medicare ID - Type Unspecified
TX7294356OtherAETNA