MEDICARE: LEVI ADAM KORAL DSOM, L.OM

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	171100000X	Acupuncturist	OM000275	PA

General Provider Information

NPI Number	:	1962035212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVI ADAM KORAL DSOM, L.OM

Provider Business Mailing Address
First Line	:	67 BUTLER ST
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-4720
Country	:	US
Telephone Number	:	570-262-1133
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 RUTTER AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4962
Country	:	US
Telephone Number	:	570-262-1133
Fax Number	:

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

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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