Provider Demographics
NPI:1699898361
Name:BARNES, BRENDA VAGENHEIM (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:VAGENHEIM
Last Name:BARNES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 KAYLEE DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3379
Mailing Address - Country:US
Mailing Address - Phone:352-205-7447
Mailing Address - Fax:
Practice Address - Street 1:2115 KAYLEE DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-3379
Practice Address - Country:US
Practice Address - Phone:352-205-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 1750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89022Medicare ID - Type Unspecified