Provider Demographics
NPI:1316005937
Name:WISDOM, KATHLEEN CAIN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CAIN
Last Name:WISDOM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7400 E KILGUS CIR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9447
Mailing Address - Country:US
Mailing Address - Phone:502-241-1499
Mailing Address - Fax:502-241-2261
Practice Address - Street 1:7400 E KILGUS CIR
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-9447
Practice Address - Country:US
Practice Address - Phone:502-241-1499
Practice Address - Fax:502-241-2261
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4139111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU36805Medicare UPIN
KY0547702Medicare PIN