Provider Demographics
NPI:1144565029
Name:MAH, KATRINA MAI (DC)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MAI
Last Name:MAH
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 1:9535 KINGS CHARTER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7939
Mailing Address - Country:US
Mailing Address - Phone:804-550-0780
Mailing Address - Fax:804-550-0782
Practice Address - Street 1:209 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2827
Practice Address - Country:US
Practice Address - Phone:804-523-8023
Practice Address - Fax:804-523-8013
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor