Provider Demographics
NPI:1215076849
Name:FAGAN, BARBARA LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYNN
Last Name:FAGAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1313 5TH ST SE
Mailing Address - Street 2:312
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4504
Mailing Address - Country:US
Mailing Address - Phone:612-379-1808
Mailing Address - Fax:612-379-1908
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:312
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:612-379-1808
Practice Address - Fax:612-379-1908
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor