Provider Demographics
NPI:1841242914
Name:JAMES R MCDERMOTT DC PC
Entity Type:Organization
Organization Name:JAMES R MCDERMOTT DC PC
Other - Org Name:HERMAN CHIROPRACTIC OF KINGSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-288-5800
Mailing Address - Street 1:569 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5731
Mailing Address - Country:US
Mailing Address - Phone:570-288-5800
Mailing Address - Fax:570-288-5900
Practice Address - Street 1:1013 LEDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-1750
Practice Address - Country:US
Practice Address - Phone:570-655-0238
Practice Address - Fax:570-288-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007572-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU79199Medicare UPIN
PA035868Medicare ID - Type Unspecified