MEDICARE: BARR FAMILY CHIROPRACTIC & SPORTS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	2310	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C03521	OTHER	MN	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	373R0CA	OTHER	MN	BLUE CROSS BLUE SHIELD GROUP NUMBER

General Provider Information

NPI Number	:	1154510451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARR FAMILY CHIROPRACTIC & SPORTS CLINIC

Provider Business Mailing Address
First Line	:	4719 BANNING AVE
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3217
Country	:	US
Telephone Number	:	651-429-2279
Fax Number	:	651-429-2361

Provider Business Practice Location Address
First Line	:	4719 BANNING AVE
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3217
Country	:	US
Telephone Number	:	651-429-2279
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES THOMAS BARR
Credential	:	D.C.
Telephone Number	:	651-429-2279

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/19/2011

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Directions to “BARR FAMILY CHIROPRACTIC & SPORTS CLINIC ” Practice Location

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