Provider Demographics
NPI:1316274442
Name:BARNEWOLT, KATHERINE E
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BARNEWOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:ZINSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:IL
Mailing Address - Zip Code:61528-0054
Mailing Address - Country:US
Mailing Address - Phone:309-691-6920
Mailing Address - Fax:309-691-6921
Practice Address - Street 1:7814 N KICKAPOO EDWARDS RD
Practice Address - Street 2:SUITE A
Practice Address - City:EDWARDS
Practice Address - State:IL
Practice Address - Zip Code:61528-9564
Practice Address - Country:US
Practice Address - Phone:309-691-6920
Practice Address - Fax:309-691-6921
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011546111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7232266OtherGROUP BCBS OF IL
ILIL3028001Medicare PIN