Provider Demographics
NPI:1871788026
Name:J. KOLLER, LLC
Entity type:Organization
Organization Name:J. KOLLER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-859-1250
Mailing Address - Street 1:16B S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:PA
Mailing Address - Zip Code:17501-1331
Mailing Address - Country:US
Mailing Address - Phone:717-859-1250
Mailing Address - Fax:717-859-1299
Practice Address - Street 1:16B S 7TH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1331
Practice Address - Country:US
Practice Address - Phone:717-859-1250
Practice Address - Fax:717-859-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007237-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007418487OtherAETNA
01729101OtherCAPITAL BLUE CROSS
1585039OtherHIGHMARK
115885OtherGEISINGER
1039440OtherASHN
021538P55OtherMEDICARE
PA49801Medicare UPIN