Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 000360 | CT |
NPI | 1265426126 |
---|---|
Provider Name | Dr. Larry W Barnett |
First Address | New Canaan, CT 06840-6522 |
Second Address | New Canaan, CT 06840-6522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 02/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050000360CT01 | ANTHEM BLUE CROSS (01) | CT |
111817001 | MEDICARE SUPPLIER # (01) | CT |
T22764 | (02) | CT |