Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 25649 | CA |
NPI | 1184747677 |
---|---|
Provider Name | Dr. Dana Barre |
First Address | Cardiff, CA 92007-5144 |
Second Address | Encinitas, CA 92024-5144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 29/04/2014 |