MEDICARE: K D CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1295399335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K D CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	223 MULBERRY ST
Second Line	:
City	:	NEWPORT
State	:	PA
Zip	:	17074-1421
Country	:	US
Telephone Number	:	717-567-3158
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 MULBERRY ST
Second Line	:
City	:	NEWPORT
State	:	PA
Zip	:	17074-1421
Country	:	US
Telephone Number	:	717-567-3158
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE WITMER DEIMLER
Credential	:	DC
Telephone Number	:	717-982-7196

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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