MEDICARE: JOHN BAARS D.C.

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	111N00000X	Chiropractor	33-0711373	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33-0711373	OTHER		TAX ID #
2	DC 15122	OTHER	CA	DC #

General Provider Information

NPI Number	:	1457421679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BAARS D.C.

Provider Business Mailing Address
First Line	:	19900 BEACH BLVD STE A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3762
Country	:	US
Telephone Number	:	714-965-9577
Fax Number	:	714-965-9580

Provider Business Practice Location Address
First Line	:	19900 BEACH BLVD STE A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3762
Country	:	US
Telephone Number	:	714-965-9577
Fax Number	:	714-965-9580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	12/15/2010

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