Healthcare Provider Details

I. General information

NPI: 1083762744
Provider Name (Legal Business Name): R BARNABAS BICKERTON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11132 W CALIFORNIA AVE STE B
YOUNGTOWN AZ
85363-1201
US

IV. Provider business mailing address

9819 N 14TH ST
PHOENIX AZ
85020-1806
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-1307
  • Fax:
Mailing address:
  • Phone: 623-975-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5687
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: