Healthcare Provider Details

I. General information

NPI: 1629237524
Provider Name (Legal Business Name): KATHLEEN BARNETT-WOLK D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 W CHARLESTON BLVD
LAS VEGAS NV
89102-1502
US

IV. Provider business mailing address

4516 W CHARLESTON BLVD
LAS VEGAS NV
89102-1502
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-8001
  • Fax: 702-259-8005
Mailing address:
  • Phone: 702-259-8001
  • Fax: 702-259-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberB00960
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: