Provider Demographics
NPI:1144314972
Name:MCQUEEN, KATHERINE F (DC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:F
Last Name:MCQUEEN
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 1:403 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3113
Mailing Address - Country:US
Mailing Address - Phone:843-464-4870
Mailing Address - Fax:843-464-9572
Practice Address - Street 1:403 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3113
Practice Address - Country:US
Practice Address - Phone:843-464-4870
Practice Address - Fax:843-464-9572
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2596GCH359Medicaid
SCCH2596GCH359Medicaid