Provider Demographics
NPI:1629388954
Name:DRAKE, KATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:DRAKE
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 1:755 SUNRISE AVE
Mailing Address - Street 2:STE 115
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4500
Mailing Address - Country:US
Mailing Address - Phone:858-232-3463
Mailing Address - Fax:
Practice Address - Street 1:755 SUNRISE AVE
Practice Address - Street 2:STE 115
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4500
Practice Address - Country:US
Practice Address - Phone:916-786-6055
Practice Address - Fax:916-786-6452
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor