Healthcare Provider Details

I. General information

NPI: 1477554376
Provider Name (Legal Business Name): JOHN ERIC LEFEVRE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 PARK ST
BLOOMSBURG PA
17815-2328
US

IV. Provider business mailing address

519 PARK ST
BLOOMSBURG PA
17815-2328
US

V. Phone/Fax

Practice location:
  • Phone: 570-784-0360
  • Fax:
Mailing address:
  • Phone: 570-784-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005505-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: