=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376301291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARNES CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2024
-----------------------------------------------------
Last Update Date | 05/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 81 WESTERN AVE
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-7338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-861-8221
-----------------------------------------------------
Fax | 207-861-7900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 WESTERN AVE
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-7338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-861-8221
-----------------------------------------------------
Fax | 207-861-7900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | TYLER BARNES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 207-837-4603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------