Provider Demographics
NPI:1336608736
Name:CASTRO, KATHERYNE (DC)
Entity Type:Individual
Prefix:
First Name:KATHERYNE
Middle Name:
Last Name:CASTRO
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 1:1503 JOHNSON FERRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9112
Mailing Address - Country:US
Mailing Address - Phone:770-906-4760
Mailing Address - Fax:
Practice Address - Street 1:1503 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9112
Practice Address - Country:US
Practice Address - Phone:770-906-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010009111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor