Provider Demographics
NPI:1548206915
Name:VOORTMANN, KATHLEEN KAY (DC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:KAY
Last Name:VOORTMANN
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 1:1101 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1437
Mailing Address - Country:US
Mailing Address - Phone:641-357-4499
Mailing Address - Fax:
Practice Address - Street 1:1101 10TH AVE N
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1437
Practice Address - Country:US
Practice Address - Phone:641-357-4499
Practice Address - Fax:641-357-4469
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38352OtherBLUECROSS/BLUE SHIELD
IAV03214Medicare UPIN
IAI14375Medicare ID - Type Unspecified