Provider Demographics
NPI:1679629893
Name:GRATKOWSKI, CATHY MARIE (DC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:GRATKOWSKI
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 1:7830 CONNECTOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1435
Mailing Address - Country:US
Mailing Address - Phone:859-525-2994
Mailing Address - Fax:859-282-4192
Practice Address - Street 1:7830 CONNECTOR DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1435
Practice Address - Country:US
Practice Address - Phone:859-525-2994
Practice Address - Fax:859-282-4192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU18969Medicare UPIN
KY6088901Medicare ID - Type Unspecified