Healthcare Provider Details

I. General information

NPI: 1902045636
Provider Name (Legal Business Name): KATIE LEE SHORT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S DIXON RD STE I
KOKOMO IN
46902-7320
US

IV. Provider business mailing address

1542 S DIXON RD STE I
KOKOMO IN
46902-7320
US

V. Phone/Fax

Practice location:
  • Phone: 765-868-6000
  • Fax:
Mailing address:
  • Phone: 765-868-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6340
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: