Provider Demographics
NPI:1942561386
Name:BARNES, CARISSA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:LYNN
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 1:3357 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2130
Mailing Address - Country:US
Mailing Address - Phone:612-240-7133
Mailing Address - Fax:612-233-5459
Practice Address - Street 1:3357 36TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2130
Practice Address - Country:US
Practice Address - Phone:612-240-7133
Practice Address - Fax:612-233-5459
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5671111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition