Provider Demographics
NPI:1700969987
Name:DELEON, JOHN P JR
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:DELEON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1062
Mailing Address - Country:US
Mailing Address - Phone:570-585-4290
Mailing Address - Fax:570-585-4299
Practice Address - Street 1:402 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1062
Practice Address - Country:US
Practice Address - Phone:570-585-4290
Practice Address - Fax:570-585-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ006621-L111N00000X, 111NN1001X, 111NS0005X, 111NX0100X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADE869489Medicare ID - Type Unspecified