Healthcare Provider Details

I. General information

NPI: 1700669934
Provider Name (Legal Business Name): KATHRYN DAANE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN SOBOTTA LMT

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 ENTERPRISE DR
SHEBOYGAN WI
53083-2245
US

IV. Provider business mailing address

4000 ENTERPRISE DR
SHEBOYGAN WI
53083-2245
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-9090
  • Fax: 920-459-7426
Mailing address:
  • Phone: 920-459-9090
  • Fax: 920-459-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number17231-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: