Provider Demographics
NPI:1053856146
Name:NIENHAUS, KATHRYN NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:NICOLE
Last Name:NIENHAUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:NIENHAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:7202 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-1321
Mailing Address - Country:US
Mailing Address - Phone:636-448-3244
Mailing Address - Fax:
Practice Address - Street 1:1561 N WARSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1107
Practice Address - Country:US
Practice Address - Phone:636-448-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016043369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor