MEDICARE: DR. KATIE JUNE OUDERKIRK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC010817	PA

General Provider Information

NPI Number	:	1588085534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE JUNE OUDERKIRK DC

Provider Business Mailing Address
First Line	:	13 BARBER RD
Second Line	:
City	:	REDFIELD
State	:	NY
Zip	:	13437-2900
Country	:	US
Telephone Number	:	315-771-5124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1704 BROADVIEW BLVD
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2123
Country	:	US
Telephone Number	:	724-448-2281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	12/18/2013

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