=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144604059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRETT FAMILY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2015
-----------------------------------------------------
Last Update Date | 07/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1724 WOODLAWN DR SUITE 7
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21207-4002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-265-9911
-----------------------------------------------------
Fax | 410-265-9914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1724 WOODLAWN DR SUITE 7
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21207-4002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-265-9911
-----------------------------------------------------
Fax | 410-265-9914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | CAROL HUTSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-251-0037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1612
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------