Provider Demographics
NPI:1134237662
Name:KAVA, KATHERINE M (DC)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:KAVA
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 1:4830 N CUMBERLAND AVE
Mailing Address - Street 2:2ND FLOOR SUITE #1
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706
Mailing Address - Country:US
Mailing Address - Phone:708-452-6722
Mailing Address - Fax:708-452-7660
Practice Address - Street 1:4830 N CUMBERLAND AVE
Practice Address - Street 2:2ND FLOOR SUITE #1
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706
Practice Address - Country:US
Practice Address - Phone:708-452-6722
Practice Address - Fax:708-452-7660
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
209464Medicare ID - Type Unspecified