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General NPI Number Information
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NPI Number | 1134451016
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Entity Type | Individual
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Provider Name | KATHRYN LEIGH MATTSON D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 1615 E 61ST ST N STE 300
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City | PARK CITY
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State | KS
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Zip | 67219-1964
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Country | US
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Telephone | 607-267-7263
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Fax |
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Provider Business Mailing Address
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Address Line | 6520 E MARJORIE ST
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City | WICHITA
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State | KS
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Zip | 67206-1424
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Country | US
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Telephone | 607-267-7263
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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 | 01-05381
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X011976-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC010385
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License Number State | PA
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