Provider Demographics
NPI:1265479190
Name:LEBARON, KELLI (DC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LEBARON
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 1:2920 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1224
Mailing Address - Country:US
Mailing Address - Phone:610-356-2341
Mailing Address - Fax:610-356-3763
Practice Address - Street 1:2920 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1224
Practice Address - Country:US
Practice Address - Phone:610-356-2341
Practice Address - Fax:610-356-3763
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU99469Medicare UPIN
PA087360Medicare ID - Type Unspecified