Provider Demographics
NPI:1801896352
Name:AYERS, KEVIN E (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:AYERS
Suffix:
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 1:202 INSPIRATION LN
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-6762
Mailing Address - Country:US
Mailing Address - Phone:570-833-5327
Mailing Address - Fax:
Practice Address - Street 1:202 INSPIRATION LN
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-6762
Practice Address - Country:US
Practice Address - Phone:570-833-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007039L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA449258OtherPENNSYLVANIA BLUE SHIELD
PA001661362Medicaid
PAAY901475Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PAU67179Medicare UPIN