Provider Demographics
NPI:1588743025
Name:BARNES, BRUCE DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DEAN
Last Name:BARNES
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 1:23710 EDMONDS WAY
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8978
Mailing Address - Country:US
Mailing Address - Phone:425-778-2100
Mailing Address - Fax:425-774-9416
Practice Address - Street 1:23710 EDMONDS WAY
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8978
Practice Address - Country:US
Practice Address - Phone:425-778-2100
Practice Address - Fax:425-774-9416
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00000748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02645Medicare UPIN