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General NPI Number Information
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NPI Number | 1114113545
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Entity Type | Organization
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Legal Business Name | FREDERICK A BARKS, JR
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 245 SCHOOL ST
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City | PUTNAM
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State | CT
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Zip | 06260-1621
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Country | US
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Telephone | 860-928-7729
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Fax | 860-928-0593
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Provider Business Mailing Address
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Address Line | 245 SCHOOL ST
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City | PUTNAM
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State | CT
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Zip | 06260-1621
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Country | US
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Telephone | 860-928-7729
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Fax | 860-928-0593
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK A BARKS JR.
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Credential | D.C.
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Telephone | 860-928-7729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 001391
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License Number State | CT
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