1225034523 NPI number — JAMES ADAM KLIAMOVICH II D.C.

Table of content: JAMES ADAM KLIAMOVICH II D.C. (NPI 1225034523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225034523 NPI number — JAMES ADAM KLIAMOVICH II D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLIAMOVICH
Provider First Name:
JAMES
Provider Middle Name:
ADAM
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225034523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 334
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWEET VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18656-0334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-477-2778
Provider Business Mailing Address Fax Number:
570-477-3572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5321 MAIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEET VALLEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18656-0334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-477-2778
Provider Business Practice Location Address Fax Number:
570-477-3572
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC006235L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NX0100X , with the licence number: DC006235L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 339411 . This is a "ADVANTRA FREEDOM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015407230003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0814753000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007640 . This is a "ASHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20039719 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2983739 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 789959 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2194938 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 45223 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 118377 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5622279 . This is a "AETNA PPO ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 825782 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 611305800 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2298072 . This is a "AETNA HMO ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 339411 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 350052217 . This is a "RAILROAD MEDICARE NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 350052217 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 789959 . This is a "FIRST PRIORITY LIFE INS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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