Provider Demographics
NPI:1689791204
Name:KELTGEN, CATHLEEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:LEE
Last Name:KELTGEN
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 1:1444 EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1240
Mailing Address - Country:US
Mailing Address - Phone:920-743-2200
Mailing Address - Fax:920-743-2250
Practice Address - Street 1:1444 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1240
Practice Address - Country:US
Practice Address - Phone:920-743-2200
Practice Address - Fax:920-743-2250
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38880000Medicaid
WI38880000Medicaid