Provider Demographics
NPI:1104448547
Name:NIEBUR, KATIE (ND, DC)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:NIEBUR
Suffix:
Gender:F
Credentials:ND, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11454 193RD ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8423
Mailing Address - Country:US
Mailing Address - Phone:708-362-2337
Mailing Address - Fax:
Practice Address - Street 1:115 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2119
Practice Address - Country:US
Practice Address - Phone:708-362-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038103439111N00000X
IL038.013439111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor