Healthcare Provider Details

I. General information

NPI: 1669461885
Provider Name (Legal Business Name): BARRY MARK TRIESTMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 05/10/2020
Certification Date: 05/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11464 E RIDGE RD
TRUCKEE CA
96161-1716
US

IV. Provider business mailing address

11464 E RIDGE RD
TRUCKEE CA
96161-1716
US

V. Phone/Fax

Practice location:
  • Phone: 530-412-0072
  • Fax: 530-550-1622
Mailing address:
  • Phone: 530-550-1688
  • Fax: 530-550-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC 25940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: