Provider Demographics
NPI:1639556244
Name:KILHEENEY, NATALIE (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KILHEENEY
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W. 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360
Mailing Address - Country:US
Mailing Address - Phone:574-855-1836
Mailing Address - Fax:
Practice Address - Street 1:318 TOSCANA BLVD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8041
Practice Address - Country:US
Practice Address - Phone:574-387-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000167A171100000X
IL198.001253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist