Provider Demographics
NPI:1962423616
Name:BREESE, KATHRYN G (DC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:G
Last Name:BREESE
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 1:909 W HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:AMADO
Mailing Address - State:AZ
Mailing Address - Zip Code:85645-9526
Mailing Address - Country:US
Mailing Address - Phone:520-398-2404
Mailing Address - Fax:
Practice Address - Street 1:210 W CONTINENTAL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1995
Practice Address - Country:US
Practice Address - Phone:520-625-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
95580Medicare UPIN
AZ75201Medicare ID - Type Unspecified