Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0005461 | FL |
NPI | 1194878363 |
---|---|
Provider Name | Craig L Barcomb |
First Address | Sarasota, FL 34239-2344 |
Second Address | Sarasota, FL 34239-2344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70963 | BLUE CROSS BLUE SHIELD (01) | FL |
CH0005461 | WORKERS COMPENSATION (01) | FL |
T55080 | (02) | FL |