1871788026 NPI number — J. KOLLER, LLC

Table of content: (NPI 1871788026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871788026 NPI number — J. KOLLER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. KOLLER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KOLLER CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1871788026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16B S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17501-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-859-1250
Provider Business Mailing Address Fax Number:
717-859-1299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16B S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17501-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-859-1250
Provider Business Practice Location Address Fax Number:
717-859-1299
Provider Enumeration Date:
09/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE ASST
Authorized Official Telephone Number:
717-859-1250

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC007237-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007418487 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01729101 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1585039 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 115885 . This is a "GEISINGER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1039440 . This is a "ASHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 021538P55 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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