Provider Demographics
NPI:1225214299
Name:K-P CHIROPRACTIC CENTER LLC.
Entity Type:Organization
Organization Name:K-P CHIROPRACTIC CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KONOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-876-4880
Mailing Address - Street 1:164 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1028
Mailing Address - Country:US
Mailing Address - Phone:570-876-4880
Mailing Address - Fax:570-876-4884
Practice Address - Street 1:164 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1028
Practice Address - Country:US
Practice Address - Phone:570-876-4880
Practice Address - Fax:570-876-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120771XRRMedicare PIN