Provider Demographics
NPI:1700810496
Name:LINK, KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:LINK
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 1:190 VINING CT
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6658
Mailing Address - Country:US
Mailing Address - Phone:386-673-3085
Mailing Address - Fax:386-673-0411
Practice Address - Street 1:190 VINING CT
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6658
Practice Address - Country:US
Practice Address - Phone:386-673-3085
Practice Address - Fax:386-673-0411
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55660Medicare UPIN
FL88047ZMedicare ID - Type Unspecified