Provider Demographics
NPI:1881669638
Name:KINGSTON CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KINGSTON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUTANOS-FELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-718-6565
Mailing Address - Street 1:183 MARKET ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5444
Mailing Address - Country:US
Mailing Address - Phone:570-718-6565
Mailing Address - Fax:570-714-8750
Practice Address - Street 1:183 MARKET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5444
Practice Address - Country:US
Practice Address - Phone:570-718-6565
Practice Address - Fax:570-714-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty