Provider Demographics
NPI:1578558565
Name:KALIE, LORI ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:KALIE
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 1:6 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3506
Mailing Address - Country:US
Mailing Address - Phone:484-577-4413
Mailing Address - Fax:484-577-4413
Practice Address - Street 1:6 N 6TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3506
Practice Address - Country:US
Practice Address - Phone:484-577-4413
Practice Address - Fax:484-577-4738
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009121111N00000X
PAAJ008956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU91510Medicare UPIN