Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIA-1576 | ID |
NPI | 1003384629 |
---|---|
Provider Name | Gary Barrow |
First Address | Victorville, CA 92392-4862 |
Second Address | Fort Irwin, CA 92310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2018 |
Last Update Date | 13/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHIA-1576 | LICENSES NUMBER (01) | ID |