Provider Demographics
NPI:1790816825
Name:KJ HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:KJ HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBARON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-356-2341
Mailing Address - Street 1:5 HADLEY LN
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1675
Mailing Address - Country:US
Mailing Address - Phone:617-529-0810
Mailing Address - Fax:610-356-3763
Practice Address - Street 1:5 HADLEY LN
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1675
Practice Address - Country:US
Practice Address - Phone:617-529-0810
Practice Address - Fax:610-356-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA127718Medicare PIN
PAU99469Medicare UPIN