=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407133051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARKER FAMILY CHIROPRACTIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2011
-----------------------------------------------------
Last Update Date | 01/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 W BROADWAY SUITE 100
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-314-0707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1662
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55362-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-314-0707
-----------------------------------------------------
Fax | 763-314-0707
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | BENNETT MICHAEL BARKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-314-0707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 5537
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------