Provider Demographics
NPI:1013798214
Name:PRAKASH, KATELYN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:
Last Name:PRAKASH
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 1:3009 MILLWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1873
Mailing Address - Country:US
Mailing Address - Phone:803-851-5450
Mailing Address - Fax:
Practice Address - Street 1:3009 MILLWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1873
Practice Address - Country:US
Practice Address - Phone:803-851-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor