Provider Demographics
NPI:1447512702
Name:FESSENDEN, KATHLEEN RAUSO (DC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:RAUSO
Last Name:FESSENDEN
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 1:11782 REAGAN ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4128
Mailing Address - Country:US
Mailing Address - Phone:562-221-4060
Mailing Address - Fax:
Practice Address - Street 1:2650 N LOS COYOTES DIAGONAL
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1355
Practice Address - Country:US
Practice Address - Phone:562-420-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor