Provider Demographics
NPI:1437109626
Name:CONABLE, KATHARINE M (DC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:M
Last Name:CONABLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8229 CLAYTON RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1155
Mailing Address - Country:US
Mailing Address - Phone:314-991-5655
Mailing Address - Fax:314-932-5080
Practice Address - Street 1:8229 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1155
Practice Address - Country:US
Practice Address - Phone:314-991-5655
Practice Address - Fax:314-932-5080
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4582036OtherAETNA
084722OtherHEALTH ALLIANCE
350033156OtherRAILROAD MEDICARE
54143OtherGROUP HEALTH PLAN
990001765OtherRR MEDICARE GROUP #
5074OtherBLUE CROSS BS OF MO
MO3930OtherLICENSE #
431260519OtherFEDERAL TAX ID
178246OtherHEALTHLINK
431260519CONOtherMERCY HEALTH PLAN
EMPIRE BLUE CROSSOther10146X
990001765Medicare ID - Type UnspecifiedGROUP ID #
MO3930OtherLICENSE #
T43251Medicare UPIN