Provider Demographics
NPI:1790067783
Name:FREGA, KATHRYN ROSE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ROSE
Last Name:FREGA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:HEMMERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1850 E 53RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2784
Mailing Address - Country:US
Mailing Address - Phone:563-359-4106
Mailing Address - Fax:563-359-4130
Practice Address - Street 1:1850 E 53RD ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2784
Practice Address - Country:US
Practice Address - Phone:563-359-4106
Practice Address - Fax:563-359-4130
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012020111N00000X
WI6028-170175F00000X
IA083863111N00000X
WI6162-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038012020OtherILLINOIS LICENSE
IA083863OtherIOWA LICENSE
WI6162-12OtherWISCONSIN CHIROPRACTIC LICENSE
WI6028-170OtherWISCONSIN NATUROPATHIC LICENSE