Provider Demographics
NPI:1487781035
Name:MCCOWN, BARRY J (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:MCCOWN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 TIERRA DEL REY STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7875
Mailing Address - Country:US
Mailing Address - Phone:619-421-0444
Mailing Address - Fax:619-421-0434
Practice Address - Street 1:1055 TIERRA DEL REY STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7875
Practice Address - Country:US
Practice Address - Phone:619-421-0444
Practice Address - Fax:619-421-0434
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0885277OtherTAX ID
CA33-0885277OtherTAX ID
CAU25884Medicare UPIN