Provider Demographics
NPI:1013010396
Name:FEDERLE, KATHERINE MARGARET (DC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARGARET
Last Name:FEDERLE
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 1:630 OAK GROVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4318
Mailing Address - Country:US
Mailing Address - Phone:650-323-6294
Mailing Address - Fax:650-324-9898
Practice Address - Street 1:630 OAK GROVE AVENUE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4318
Practice Address - Country:US
Practice Address - Phone:650-323-6294
Practice Address - Fax:650-324-9898
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC151960Medicare ID - Type UnspecifiedCHIROPRACTOR