MEDICARE: MRS. JILL MARIE KONOSKY D.C.

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	DC009713	PA

General Provider Information

NPI Number	:	1558410977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL MARIE KONOSKY D.C.

Provider Business Mailing Address
First Line	:	123 VALLEY RD W
Second Line	:
City	:	KUNKLETOWN
State	:	PA
Zip	:	18058-7756
Country	:	US
Telephone Number	:	570-351-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 SCRANTON CARBONDALE HWY
Second Line	:
City	:	EYNON
State	:	PA
Zip	:	18403-1028
Country	:	US
Telephone Number	:	570-876-4880
Fax Number	:	570-876-4884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	06/23/2020

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