Provider Demographics
NPI:1649572496
Name:BARANOSKI, CARISSA M (DC)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:M
Last Name:BARANOSKI
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 1:3037 THEODORE ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5191
Mailing Address - Country:US
Mailing Address - Phone:815-582-0006
Mailing Address - Fax:815-741-9552
Practice Address - Street 1:3037 THEODORE ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5191
Practice Address - Country:US
Practice Address - Phone:815-582-0006
Practice Address - Fax:815-741-9552
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor