Provider Demographics
NPI:1285791616
Name:MCDONALD, KATHLEEN M (DC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:MCDONALD
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 1:127 N WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-0816
Mailing Address - Country:US
Mailing Address - Phone:608-588-7400
Mailing Address - Fax:608-588-7400
Practice Address - Street 1:127 N WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-0816
Practice Address - Country:US
Practice Address - Phone:608-588-7400
Practice Address - Fax:608-588-7400
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1756111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT62719Medicare UPIN
WI000075649Medicare PIN