=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669886263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARBOUR CHIROPRACTIC CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2014
-----------------------------------------------------
Last Update Date | 06/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 S MAIN ST
-----------------------------------------------------
City | PHILIPPI
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26416-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-457-4900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 S MAIN ST
-----------------------------------------------------
City | PHILIPPI
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26416-1239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-457-4900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. GARY NEAL BAKER JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 304-457-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 842
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------