Provider Demographics
NPI:1861438632
Name:BARAK, RON (DC)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:BARAK
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 1:12520 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2336
Mailing Address - Country:US
Mailing Address - Phone:818-755-0741
Mailing Address - Fax:818-762-4869
Practice Address - Street 1:12520 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-2336
Practice Address - Country:US
Practice Address - Phone:818-755-0741
Practice Address - Fax:818-762-4869
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23735111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23735Medicare ID - Type Unspecified