Provider Demographics
NPI:1891249553
Name:TILTON, KATHERINE NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:NICOLE
Last Name:TILTON
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 1:2845 THORNHILLS AVE SE
Mailing Address - Street 2:SUITE Z
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7193
Mailing Address - Country:US
Mailing Address - Phone:616-949-1888
Mailing Address - Fax:616-949-9602
Practice Address - Street 1:2845 THORNHILLS AVE SE
Practice Address - Street 2:SUITE Z
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7193
Practice Address - Country:US
Practice Address - Phone:616-949-1888
Practice Address - Fax:616-949-9602
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010290111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor