Healthcare Provider Details

I. General information

NPI: 1235545245
Provider Name (Legal Business Name): KATRINA KAHOOK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S DIXIE HWY
LAKE WORTH FL
33460-4442
US

IV. Provider business mailing address

409 S DIXIE HWY
LAKE WORTH FL
33460-4442
US

V. Phone/Fax

Practice location:
  • Phone: 561-582-5433
  • Fax:
Mailing address:
  • Phone: 561-582-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: