Provider Demographics
NPI:1912127176
Name:BARNETT, MIKKY DEAN (DCPS)
Entity Type:Individual
Prefix:
First Name:MIKKY
Middle Name:DEAN
Last Name:BARNETT
Suffix:
Gender:M
Credentials:DCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-0220
Mailing Address - Country:US
Mailing Address - Phone:360-629-2410
Mailing Address - Fax:
Practice Address - Street 1:9806 270TH ST NW #C
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-0220
Practice Address - Country:US
Practice Address - Phone:360-629-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2097400Medicaid
T02946Medicare UPIN