Provider Demographics
NPI:1174556203
Name:ALDERETE, KATHLEEN ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANNE
Last Name:ALDERETE
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 1:2725 JEFFERSON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1706
Mailing Address - Country:US
Mailing Address - Phone:760-730-0180
Mailing Address - Fax:760-730-0187
Practice Address - Street 1:2725 JEFFERSON ST STE 3
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1706
Practice Address - Country:US
Practice Address - Phone:760-730-0180
Practice Address - Fax:760-730-0187
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26330Medicare ID - Type UnspecifiedPROVIDER NUMBER