Provider Demographics
NPI:1790752541
Name:KIELBASA, LEONARD (DC)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:KIELBASA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3166
Mailing Address - Country:US
Mailing Address - Phone:717-796-1494
Mailing Address - Fax:
Practice Address - Street 1:419 VILLAGE DR STE 2
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6943
Practice Address - Country:US
Practice Address - Phone:717-241-9355
Practice Address - Fax:717-241-9356
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50067419OtherCAPITAL BLUE CROSS
PA1566206OtherHIGHMARK
PA111404Medicare PIN