Provider Demographics
NPI:1891749735
Name:BELL, KATHLEEN ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:BELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:GOERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5303 20TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5071
Mailing Address - Country:US
Mailing Address - Phone:941-792-1150
Mailing Address - Fax:
Practice Address - Street 1:11023 GATEWOOD DR STE 101
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4945
Practice Address - Country:US
Practice Address - Phone:941-744-1585
Practice Address - Fax:941-744-1572
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 7425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55685XMedicare UPIN