Individual
DR. DIANE MAE JEROME BARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
1526 GRAND AVE, SAINT PAUL, MN 55105-2227
(651) 690-9366
(651) 690-4736
Mailing address
12450 UPPER HEATHER AVE N, HUGO, MN 55038-8310
(651) 429-4047
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3422
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0140
HEA;TH SERVICE MANAGEMENT
MN
01
—
231957
CHIROCARE
MN
01
—
44-42579
MEDICA
MN
01
—
53971700
MEDICAL ASSISTANCE
MN
01
—
5C183JE
B:UE CROSS
MN
Enumeration date
09/15/2006
Last updated
03/06/2019
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