Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC009879 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | AJ009695 | PA |
NPI | 1396927901 |
---|---|
Provider Name | Dr. Moses Micah Jevicky |
First Address | Indiana, PA 15701-3600 |
Second Address | Indiana, PA 15701-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 05/12/2007 |