Provider Demographics
NPI:1760658546
Name:KATHY J. PANSEGRAU, DC, PSC
Entity Type:Organization
Organization Name:KATHY J. PANSEGRAU, DC, PSC
Other - Org Name:360 DEGREE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANSEGRAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-703-2658
Mailing Address - Street 1:6402 WESTWIND WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014
Mailing Address - Country:US
Mailing Address - Phone:502-241-8939
Mailing Address - Fax:502-241-8940
Practice Address - Street 1:6402 WESTWIND WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-241-8939
Practice Address - Fax:502-241-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty