MEDICARE: K-P CHIROPRACTIC CENTER LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC009713	PA

General Provider Information

NPI Number	:	1225214299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K-P CHIROPRACTIC CENTER LLC.

Provider Business Mailing Address
First Line	:	164 SCRANTON CARBONDALE HWY
Second Line	:
City	:	EYNON
State	:	PA
Zip	:	18403-1028
Country	:	US
Telephone Number	:	570-876-4880
Fax Number	:	570-876-4884

Provider Business Practice Location Address
First Line	:	164 SCRANTON CARBONDALE HWY
Second Line	:
City	:	EYNON
State	:	PA
Zip	:	18403-1028
Country	:	US
Telephone Number	:	570-876-4880
Fax Number	:	570-876-4884

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JILL M KONOSKY
Credential	:	DC
Telephone Number	:	570-876-4880

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	03/24/2008

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