Healthcare Provider Details

I. General information

NPI: 1760615868
Provider Name (Legal Business Name): STEVEN ALLEN BARRACK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44751 VILLAGE CT # 300
PALM DESERT CA
92260-3815
US

IV. Provider business mailing address

44751 VILLAGE CT # 300
PALM DESERT CA
92260-3815
US

V. Phone/Fax

Practice location:
  • Phone: 760-332-9775
  • Fax:
Mailing address:
  • Phone: 760-332-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number016253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: