MEDICARE: LEONARD KIELBASA DC

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	DC009126	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50067419	OTHER	PA	CAPITAL BLUE CROSS
2	1566206	OTHER	PA	HIGHMARK

General Provider Information

NPI Number	:	1790752541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD KIELBASA DC

Provider Business Mailing Address
First Line	:	67 HONEYSUCKLE DR
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17050-3166
Country	:	US
Telephone Number	:	717-796-1494
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 VILLAGE DR STE 2
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-6943
Country	:	US
Telephone Number	:	717-241-9355
Fax Number	:	717-241-9356

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	06/30/2014

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Directions to “ LEONARD KIELBASA DC” Practice Location

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