Provider Demographics
NPI:1659666220
Name:KLEIN, ROBERTA (LDN, DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LDN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 MEMORIAL HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9228
Mailing Address - Country:US
Mailing Address - Phone:570-675-3833
Mailing Address - Fax:
Practice Address - Street 1:3130 MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9228
Practice Address - Country:US
Practice Address - Phone:570-675-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002910L111N00000X
PADN001671133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered