Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038011546 | IL |
N | 111NP0017X | Pediatric Chiropractor | 038011546 | IL |
NPI | 1316274442 |
---|---|
Provider Name | Katherine E Barnewolt |
First Address | Edwards, IL 61528-0054 |
Second Address | Edwards, IL 61528-9564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2009 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7232266 | GROUP BCBS OF IL (01) | IL |