Provider Demographics
NPI:1659677979
Name:KILPATRICK, KATHRYN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4270 PLAINFIELD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1603
Mailing Address - Country:US
Mailing Address - Phone:616-364-6275
Mailing Address - Fax:
Practice Address - Street 1:4270 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1603
Practice Address - Country:US
Practice Address - Phone:616-364-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor