Provider Demographics
NPI:1598844961
Name:ANDERSON, KATHLEEN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:A
Last Name:ANDERSON
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 1:6939 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6847
Mailing Address - Country:US
Mailing Address - Phone:727-847-1260
Mailing Address - Fax:727-847-1769
Practice Address - Street 1:6939 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6847
Practice Address - Country:US
Practice Address - Phone:727-847-1260
Practice Address - Fax:727-847-1769
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4109111N00000X
FLMM25289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist