Provider Demographics
NPI:1588085534
Name:OUDERKIRK, KATIE JUNE (DC)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JUNE
Last Name:OUDERKIRK
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 1:13 BARBER RD
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13437-2900
Mailing Address - Country:US
Mailing Address - Phone:315-771-5124
Mailing Address - Fax:
Practice Address - Street 1:1704 BROADVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2123
Practice Address - Country:US
Practice Address - Phone:724-448-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor