Healthcare Provider Details

I. General information

NPI: 1184747677
Provider Name (Legal Business Name): DANA BARRE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SANTA FE DR STE A
ENCINITAS CA
92024-5144
US

IV. Provider business mailing address

2045 SAN ELIJO AVE
CARDIFF CA
92007-5144
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-8877
  • Fax: 760-944-8897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number25649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: