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General NPI Number Information
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NPI Number | 1174745277
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Entity Type | Organization
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Legal Business Name | MCGOVERN, P.C.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 WILKES-BARRE TWP. BLVD.
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City | WILKES-BARRE
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State | PA
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Zip | 18702
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Country | US
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Telephone | 570-970-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 302 WILKES-BARRE TWP. BLVD.
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City | WILKES-BARRE
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State | PA
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Zip | 18702
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Country | US
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Telephone | 570-970-8999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAN MARIE MCGOVERN
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Credential | D.C.
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Telephone | 570-970-8999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC007412L
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License Number State | PA
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