Provider Demographics
NPI:1871027599
Name:KETNER, THOMAS RONALD JR (DC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RONALD
Last Name:KETNER
Suffix:JR
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:P.O. BOX 407
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033
Mailing Address - Country:US
Mailing Address - Phone:215-443-5626
Mailing Address - Fax:
Practice Address - Street 1:1000 S. EASTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:215-443-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor