Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | AJ006621-L | PA |
N | 111NN1001X | Nutrition | AJ006621-L | PA |
N | 111NS0005X | Chiropractic Sports Physician | AJ006621-L | PA |
N | 111NX0100X | Occupational Health | AJ006621-L | PA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | AJ006621-L | PA |
NPI | 1700969987 |
---|---|
Provider Name | Dr. John P Deleon JR. |
First Address | Clarks Summit, PA 18411-1062 |
Second Address | Clarks Summit, PA 18411-1062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 20/09/2013 |