Healthcare Provider Details

I. General information

NPI: 1174745277
Provider Name (Legal Business Name): MCGOVERN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WILKES-BARRE TWP. BLVD.
WILKES-BARRE PA
18702
US

IV. Provider business mailing address

302 WILKES-BARRE TWP. BLVD.
WILKES-BARRE PA
18702
US

V. Phone/Fax

Practice location:
  • Phone: 570-970-8999
  • Fax:
Mailing address:
  • Phone: 570-970-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC007412L
License Number StatePA

VIII. Authorized Official

Name: DR. JAN MARIE MCGOVERN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 570-970-8999