Provider Demographics
NPI:1902842958
Name:QUAM, BARRY A (DC PS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:QUAM
Suffix:
Gender:M
Credentials:DC PS
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Mailing Address - Street 1:25012 - 104TH AVE SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2821
Mailing Address - Country:US
Mailing Address - Phone:253-854-1233
Mailing Address - Fax:253-854-1297
Practice Address - Street 1:25012 104TH AVE SE
Practice Address - Street 2:SUITE E
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-2821
Practice Address - Country:US
Practice Address - Phone:253-854-1233
Practice Address - Fax:253-854-1297
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WACH00001274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0003977OtherL&I
WA459124001OtherGROUP HEALTH INS
QU5942OtherREGENCE INSURANCE
WA2023703Medicaid
911088995OtherTAX ID
QU0183OtherGROUP #
193043300OtherUS DEPT OF LABOR FEDERAL
601798401OtherWASHINGTON STATE UBI
WA459124001OtherGROUP HEALTH INS
T01782Medicare UPIN