Provider Demographics
NPI:1356794135
Name:BASS, KATLYN MARIE (DC)
Entity type:Individual
Prefix:MRS
First Name:KATLYN
Middle Name:MARIE
Last Name:BASS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:MARIE
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1902 5TH AVE S SUITE 5
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303
Mailing Address - Country:US
Mailing Address - Phone:763-427-7869
Mailing Address - Fax:763-427-7869
Practice Address - Street 1:1902 5TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4361
Practice Address - Country:US
Practice Address - Phone:763-427-7869
Practice Address - Fax:763-427-7869
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor