Provider Demographics
NPI:1104865203
Name:BARNUM, ROBERT LEWIS (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:BARNUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PENNY LN
Mailing Address - Street 2:P.O. BOX 709
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2993
Mailing Address - Country:US
Mailing Address - Phone:252-726-3324
Mailing Address - Fax:252-726-9551
Practice Address - Street 1:202 PENNY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4305
Practice Address - Country:US
Practice Address - Phone:252-726-3324
Practice Address - Fax:252-726-9551
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890253YMedicaid
NC0253YOtherBCBS
NC2448563Medicare PIN