Provider Demographics
NPI:1477554376
Name:LEFEVRE, JOHN ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:LEFEVRE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2328
Mailing Address - Country:US
Mailing Address - Phone:570-784-0360
Mailing Address - Fax:
Practice Address - Street 1:519 PARK ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2328
Practice Address - Country:US
Practice Address - Phone:570-784-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005505-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0769702OtherKEYSTONE
PA02386600OtherCAPITOL BLUE CROSS
PA769702OtherBLUE SHIELD
PAU49631Medicare UPIN
PA0769702OtherKEYSTONE