Provider Demographics
NPI:1811207533
Name:KRAVITZ, IDA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:IDA
Middle Name:MARIE
Last Name:KRAVITZ
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 1:834 DEMUNDS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-6203
Mailing Address - Country:US
Mailing Address - Phone:570-371-7798
Mailing Address - Fax:
Practice Address - Street 1:834 DEMUNDS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-6203
Practice Address - Country:US
Practice Address - Phone:570-371-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor