Provider Demographics
NPI:1194449041
Name:ZIETZ, KATHERINE MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:ZIETZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3361 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8664
Mailing Address - Country:US
Mailing Address - Phone:319-480-7225
Mailing Address - Fax:
Practice Address - Street 1:3361 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8664
Practice Address - Country:US
Practice Address - Phone:319-480-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5668-12111N00000X
MTCHI-CHI-LIC-6785111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor