Provider Demographics
NPI:1639255508
Name:BRAUN, KATHRYN (DC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:BRAUN
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:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548-0354
Mailing Address - Country:US
Mailing Address - Phone:309-367-9788
Mailing Address - Fax:309-367-9817
Practice Address - Street 1:119 E PARTRIDGE ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-0354
Practice Address - Country:US
Practice Address - Phone:309-367-9788
Practice Address - Fax:309-367-9817
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10232011OtherBCBS
ILP00170382OtherRAIL ROAD MEDICARE
ILK11015Medicare ID - Type Unspecified