Provider Demographics
NPI:1538208822
Name:BARRETT, JOHN ANDREW (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:BARRETT
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 1:8177 NITTANY VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-8802
Mailing Address - Country:US
Mailing Address - Phone:570-726-4911
Mailing Address - Fax:570-726-4911
Practice Address - Street 1:8177 NITTANY VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-8802
Practice Address - Country:US
Practice Address - Phone:570-726-4911
Practice Address - Fax:570-726-4911
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005455L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
5073038OtherAETNA
PA0014403990005Medicaid
812867OtherFIRST PRIORITY HEALTH
812867OtherFIRST PRIORITY HEALTH