Healthcare Provider Details

I. General information

NPI: 1790816825
Provider Name (Legal Business Name): KJ HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HADLEY LN
GLEN MILLS PA
19342-1675
US

IV. Provider business mailing address

5 HADLEY LN
GLEN MILLS PA
19342-1675
US

V. Phone/Fax

Practice location:
  • Phone: 617-529-0810
  • Fax: 610-356-3763
Mailing address:
  • Phone: 617-529-0810
  • Fax: 610-356-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLI LEBARON
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 610-356-2341