Provider Demographics
NPI:1457323701
Name:SONLEITNER, KATHLEEN JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JESSICA
Last Name:SONLEITNER
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:PO BOX 371
Mailing Address - Street 2:514 N LAWLER STREET
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301
Mailing Address - Country:US
Mailing Address - Phone:605-995-6055
Mailing Address - Fax:605-995-6033
Practice Address - Street 1:514 N LAWLER STREET
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301
Practice Address - Country:US
Practice Address - Phone:605-995-6055
Practice Address - Fax:605-995-6033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006665OtherBCBS
SD0006665OtherBCBS