Provider Demographics
NPI:1487276408
Name:WILLIMETZ, KATHRYN MICHELLE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:WILLIMETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 VINTAGE CT
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-8011
Mailing Address - Country:US
Mailing Address - Phone:816-876-4577
Mailing Address - Fax:
Practice Address - Street 1:2330 VINTAGE CT
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-8011
Practice Address - Country:US
Practice Address - Phone:816-876-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty