Provider Demographics
NPI:1275736696
Name:ALAN H KUNKEL JR DC PC
Entity Type:Organization
Organization Name:ALAN H KUNKEL JR DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BACKENSTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-751-1289
Mailing Address - Street 1:964 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-1635
Mailing Address - Country:US
Mailing Address - Phone:610-863-9220
Mailing Address - Fax:610-863-8344
Practice Address - Street 1:964 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1635
Practice Address - Country:US
Practice Address - Phone:610-863-9220
Practice Address - Fax:610-863-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001547L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA151631OtherHIGHMARK
PA151631OtherHIGHMARK
PA151631Medicare ID - Type Unspecified