Healthcare Provider Details

I. General information

NPI: 1770935454
Provider Name (Legal Business Name): CHANEL BARNES DC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 03/13/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18062 IRVINE BLVD STE 302
TUSTIN CA
92780-3358
US

IV. Provider business mailing address

18062 IRVINE BLVD STE 302
TUSTIN CA
92780-3358
US

V. Phone/Fax

Practice location:
  • Phone: 877-660-2199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33706
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: