Provider Demographics
NPI:1699256701
Name:MCDERMOTT, KATELYN JENAE (DC)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:JENAE
Last Name:MCDERMOTT
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 1:5093 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:JENNERS
Mailing Address - State:PA
Mailing Address - Zip Code:15546-9606
Mailing Address - Country:US
Mailing Address - Phone:814-629-5581
Mailing Address - Fax:
Practice Address - Street 1:5093 FRONT ST
Practice Address - Street 2:
Practice Address - City:JENNERS
Practice Address - State:PA
Practice Address - Zip Code:15546-9606
Practice Address - Country:US
Practice Address - Phone:814-629-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty