Provider Demographics
NPI:1932220555
Name:BARANOWSKI, DEAN
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:BARANOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N O CONNOR RD STE 110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-8807
Mailing Address - Country:US
Mailing Address - Phone:972-258-6220
Mailing Address - Fax:
Practice Address - Street 1:3100 N O CONNOR RD STE 110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8807
Practice Address - Country:US
Practice Address - Phone:972-258-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8665111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611867Medicare PIN