Provider Demographics
NPI:1942682067
Name:THRIVE CHIROPRACTIC & YOGA LLC
Entity Type:Organization
Organization Name:THRIVE CHIROPRACTIC & YOGA LLC
Other - Org Name:THRIVE CHIROPRACTIC, NUTRITION, & YOGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARNEWOLT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-615-1319
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 1:193 SAN MARCO AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2733
Practice Address - Country:US
Practice Address - Phone:904-687-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1922352640Medicare UPIN
FL1548642085Medicare UPIN