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General NPI Number Information
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NPI Number | 1396841540
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Entity Type | Individual
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Provider Name | DIANE MAE JEROME BARRY DC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1526 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2227
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Country | US
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Telephone | 651-690-9366
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Fax | 651-690-4736
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Provider Business Mailing Address
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Address Line | 12450 UPPER HEATHER AVE N
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City | HUGO
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State | MN
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Zip | 55038-8310
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Country | US
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Telephone | 651-429-4047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3422
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License Number State | MN
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