Provider Demographics
NPI:1184799371
Name:KAESBEREG, KENDRA P (DC)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:P
Last Name:KAESBEREG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KENDRA
Other - Middle Name:P
Other - Last Name:KAESBERG-WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:100 MASCOUTAH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MASCOUTAH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3801
Practice Address - Country:US
Practice Address - Phone:618-233-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005236111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL81271Medicare ID - Type Unspecified