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General NPI Number Information
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NPI Number | 1093526410
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Entity Type | Individual
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Provider Name | KATHARINE RENEE ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 800 GENEVA PKWY N # 102
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City | LAKE GENEVA
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State | WI
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Zip | 53147-5701
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Country | US
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Telephone | 262-248-4105
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Fax |
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Provider Business Mailing Address
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Address Line | 32434 N ALMOND RD
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City | GRAYSLAKE
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State | IL
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Zip | 60030-9707
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Country | US
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Telephone | 224-944-6535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6266-12
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License Number State | WI
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