Provider Demographics
NPI:1790152445
Name:KB CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KB CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:KOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-466-2953
Mailing Address - Street 1:27 W MOHLER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9029
Mailing Address - Country:US
Mailing Address - Phone:717-739-0134
Mailing Address - Fax:717-738-0136
Practice Address - Street 1:27 W MOHLER CHURCH RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9029
Practice Address - Country:US
Practice Address - Phone:717-739-0134
Practice Address - Fax:717-738-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty