Provider Demographics
NPI:1689113649
Name:HAESE, KAITLYN (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:HAESE
Suffix:
Gender:F
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SE 196TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8861
Mailing Address - Country:US
Mailing Address - Phone:503-660-8154
Mailing Address - Fax:888-316-1430
Practice Address - Street 1:3400 SE 196TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8861
Practice Address - Country:US
Practice Address - Phone:503-660-8154
Practice Address - Fax:888-316-1430
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60723092111N00000X, 111NP0017X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician