Provider Demographics
NPI:1528400991
Name:JAMES A KLIAMOVICH II
Entity Type:Organization
Organization Name:JAMES A KLIAMOVICH II
Other - Org Name:KLIAMOVICH CHIROPRACTIC OFFICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/D.C.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KLIAMOVICH
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:570-477-2778
Mailing Address - Street 1:5321 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2340
Mailing Address - Country:US
Mailing Address - Phone:570-477-2778
Mailing Address - Fax:570-477-3572
Practice Address - Street 1:5321 MAIN RD
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2340
Practice Address - Country:US
Practice Address - Phone:570-477-2778
Practice Address - Fax:570-477-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006235L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10930114OtherCAQH ID
PA00015407230003Medicaid
0814753000OtherINDEPENDENCE BLUE CROSS
PA789959OtherHIGHMARK BLUE SHIELD
PAU57016Medicare UPIN