Provider Demographics
NPI:1518561638
Name:SELF, KATELYN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:LEE
Last Name:SELF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATELYN
Other - Middle Name:LEE
Other - Last Name:GATROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1926 SECLUSION DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6826
Mailing Address - Country:US
Mailing Address - Phone:719-439-8898
Mailing Address - Fax:
Practice Address - Street 1:1541 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4607
Practice Address - Country:US
Practice Address - Phone:352-732-5590
Practice Address - Fax:352-732-0292
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor