Provider Demographics
NPI:1134451016
Name:MATTSON, KATHRYN LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LEIGH
Last Name:MATTSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 E MARJORIE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1424
Mailing Address - Country:US
Mailing Address - Phone:607-267-7263
Mailing Address - Fax:
Practice Address - Street 1:1615 E 61ST ST N STE 300
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-1964
Practice Address - Country:US
Practice Address - Phone:607-267-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05381111N00000X
NYX011976-1111N00000X
PADC010385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor