Provider Demographics
NPI:1629548680
Name:BUELTMANN, KATHRYN (DC)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:BUELTMANN
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 1:4600 S LINDBERGH BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1831
Mailing Address - Country:US
Mailing Address - Phone:314-346-6822
Mailing Address - Fax:
Practice Address - Street 1:4600 S LINDBERGH BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1831
Practice Address - Country:US
Practice Address - Phone:314-346-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015001855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor