Provider Demographics
NPI:1043276132
Name:KOONS, RICHARD KENTON (D C)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KENTON
Last Name:KOONS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 REINOEHL ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-2842
Mailing Address - Country:US
Mailing Address - Phone:717-273-3741
Mailing Address - Fax:717-273-3741
Practice Address - Street 1:1123 REINOEHL ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-2842
Practice Address - Country:US
Practice Address - Phone:717-273-3741
Practice Address - Fax:717-273-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001697L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064111OtherHIGHMARK