Healthcare Provider Details

I. General information

NPI: 1902197551
Provider Name (Legal Business Name): EMILY BARKS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MILWAUKEE ST SUITE 240
KIRKWOOD MO
63122-7356
US

IV. Provider business mailing address

304 PARK ST
FARMINGTON MO
63640-2654
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-1502
  • Fax:
Mailing address:
  • Phone: 573-631-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2011013812
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: