Provider Demographics
NPI:1457904690
Name:BLAINE, KATHLEEN OHARA (DC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:OHARA
Last Name:BLAINE
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 1:353 PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2641
Mailing Address - Country:US
Mailing Address - Phone:610-717-8333
Mailing Address - Fax:
Practice Address - Street 1:816 W SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1222
Practice Address - Country:US
Practice Address - Phone:445-544-0016
Practice Address - Fax:888-892-3138
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor