Provider Demographics
NPI:1558336859
Name:KOVAL, PENNY STINE (DC)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:STINE
Last Name:KOVAL
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 1:234 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9731
Mailing Address - Country:US
Mailing Address - Phone:717-367-0844
Mailing Address - Fax:
Practice Address - Street 1:475 W GOVERNOR RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2217
Practice Address - Country:US
Practice Address - Phone:717-533-0881
Practice Address - Fax:717-533-2155
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005408L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0024547OtherGROUP MEDICARE
PA7927705OtherAETNA HMO
PAK002139OtherHIGHMARK
PA3794718OtherAETNA
PA358450OtherHIGHMARK GROUP
PA3794718OtherAETNA
PAU42541Medicare UPIN