Provider Demographics
NPI:1548642085
Name:BARNEWOLT, KRISTI (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:
Last Name:BARNEWOLT
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 1:193 SAN MARCO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2733
Mailing Address - Country:US
Mailing Address - Phone:904-615-1319
Mailing Address - Fax:
Practice Address - Street 1:2208 COMMODORES CLUB BLVD
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-9161
Practice Address - Country:US
Practice Address - Phone:904-687-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-21
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor