Provider Demographics
NPI:1700217890
Name:CONNORS, KAITLYN MELISSA
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:MELISSA
Last Name:CONNORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALNUTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7244
Mailing Address - Country:US
Mailing Address - Phone:570-262-8869
Mailing Address - Fax:
Practice Address - Street 1:150 MUNDY ST
Practice Address - Street 2:MAC IV BUILDING
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6830
Practice Address - Country:US
Practice Address - Phone:570-824-0930
Practice Address - Fax:570-824-7755
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4177518OtherAETNA
PA003013331OtherHIGHMARK BLUE SHIELD
PA1700217890OtherVIBRA HEALTH PLAN
PA1700217890OtherGHP FAMILY
PA50153952OtherCAPITAL BLUE CROSS
PA102895430-0002Medicaid
PA008246OtherOPTUM
PA25-1645055OtherHUMANA/CHOICE CARE
PA50153952OtherCAPITAL BLUE CROSS