Healthcare Provider Details

I. General information

NPI: 1043276132
Provider Name (Legal Business Name): RICHARD KENTON KOONS D C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 REINOEHL ST
LEBANON PA
17046-2842
US

IV. Provider business mailing address

1123 REINOEHL ST
LEBANON PA
17046-2842
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-3741
  • Fax: 717-273-3741
Mailing address:
  • Phone: 717-273-3741
  • Fax: 717-273-3741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC001697L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: