Provider Demographics
NPI:1831182310
Name:CLARKIN-DEDIO, KATHLEEN CAREY (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CAREY
Last Name:CLARKIN-DEDIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:CAREY
Other - Last Name:CLARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3733 KARICIO LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6829
Mailing Address - Country:US
Mailing Address - Phone:928-442-0202
Mailing Address - Fax:928-446-8858
Practice Address - Street 1:3733 KARICIO LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6829
Practice Address - Country:US
Practice Address - Phone:928-442-0202
Practice Address - Fax:928-446-8858
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO11437111N00000X
PADC004989L111N00000X
AZ8516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01870522Medicaid
PA201967OtherUPMC
PAU48594OtherUPMC
PA001350853OtherKEYSTONE HEALTH PLAN WEST
PA01870522Medicaid
PA405603Medicare ID - Type Unspecified