Provider Demographics
NPI:1063952935
Name:BRANDT, KATHLEEN F (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:F
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:F
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:20 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-5322
Mailing Address - Country:US
Mailing Address - Phone:845-292-3455
Mailing Address - Fax:
Practice Address - Street 1:20 GREGORY ST
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-5322
Practice Address - Country:US
Practice Address - Phone:845-887-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013131111N00000X
PADC011226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor