Provider Demographics
NPI:1043648751
Name:BARKER, JASON WYATT (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WYATT
Last Name:BARKER
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 1:6000 MEADOWBROOK MALL CT STE 3A
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8775
Mailing Address - Country:US
Mailing Address - Phone:336-893-5662
Mailing Address - Fax:
Practice Address - Street 1:6000 MEADOWBROOK MALL CT STE 3A
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8775
Practice Address - Country:US
Practice Address - Phone:336-893-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor