Provider Demographics
NPI:1629046032
Name:GARLAN, JOHANNA LEAH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:LEAH
Last Name:GARLAN
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:PO BOX 27
Mailing Address - Street 2:1281 RTE 113
Mailing Address - City:BLOOMING GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:18911-0027
Mailing Address - Country:US
Mailing Address - Phone:215-257-3938
Mailing Address - Fax:215-257-3646
Practice Address - Street 1:1281 RTE 113
Practice Address - Street 2:
Practice Address - City:BLOOMING GLEN
Practice Address - State:PA
Practice Address - Zip Code:18911-0027
Practice Address - Country:US
Practice Address - Phone:215-257-3938
Practice Address - Fax:215-257-3646
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008808111N00000X
AC000968171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7951576OtherAETNA
PA1538732OtherBLUE CROSS BLUE SHIELD
PA8481406OtherCIGNA
PA2223241000OtherKEYSTONE
PA076343Medicare ID - Type Unspecified
PA1538732OtherBLUE CROSS BLUE SHIELD