Provider Demographics
NPI:1609877604
Name:BARKS, FREDERICK ARTHUR JR (DC)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ARTHUR
Last Name:BARKS
Suffix:JR
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 1:245 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1621
Mailing Address - Country:US
Mailing Address - Phone:860-928-7729
Mailing Address - Fax:860-928-0593
Practice Address - Street 1:245 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1621
Practice Address - Country:US
Practice Address - Phone:860-928-7729
Practice Address - Fax:860-928-0593
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001391111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001391CT02OtherBLUE CROSS OF CT
CT0698592002OtherCIGNA
CT3823400OtherAETNA
MAAA32943OtherHARVARD PILGRIM
CT010391OtherCONNECTICARE
CT2V5130OtherHEALTHNET
RI412398OtherBLUE CHIP OF RI
CT1030756OtherASHN
CT29336-1OtherBCBS OF RI
CT4404611OtherUNITED HEALTHCARE
CTP2686322OtherOXFORD
CT2V5130OtherHEALTHNET
CT4404611OtherUNITED HEALTHCARE
CTU83407Medicare UPIN