Provider Demographics
NPI:1174764468
Name:ED BARKER, D.C., LLC
Entity type:Organization
Organization Name:ED BARKER, D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:ED
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LLC
Authorized Official - Phone:407-628-1900
Mailing Address - Street 1:430 LAKE HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5907
Mailing Address - Country:US
Mailing Address - Phone:407-628-1900
Mailing Address - Fax:407-628-4811
Practice Address - Street 1:430 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5907
Practice Address - Country:US
Practice Address - Phone:407-628-1900
Practice Address - Fax:407-628-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL09000021705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88342OtherMEDICARE PTCAN