Provider Demographics
NPI:1508834086
Name:PANSEGRAU, KATHY J (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:PANSEGRAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1885 PALM COVE BLVD
Mailing Address - Street 2:APT. #202
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6787
Mailing Address - Country:US
Mailing Address - Phone:561-703-2658
Mailing Address - Fax:
Practice Address - Street 1:750 E SAMPLE RD
Practice Address - Street 2:BUILDING 3 SUITE 1
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5144
Practice Address - Country:US
Practice Address - Phone:954-782-8200
Practice Address - Fax:954-782-8909
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 8430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV11021Medicare UPIN