Provider Demographics
NPI:1578604575
Name:BYRNE, JOAN KIMBERLY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:KIMBERLY
Last Name:BYRNE
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 1:3201 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0440
Mailing Address - Country:US
Mailing Address - Phone:812-204-1700
Mailing Address - Fax:
Practice Address - Street 1:3201 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0440
Practice Address - Country:US
Practice Address - Phone:812-476-3235
Practice Address - Fax:812-476-3235
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001026A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100247640AMedicaid
IN350011420OtherCHIROPRACTOR
IN000000184475OtherCHIROPRACTOR
IN5211042OtherCHIROPRACTOR
IN100247640AMedicaid