Provider Demographics
NPI:1366634164
Name:KLEIN, ALBERT R JR (DC)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:R
Last Name:KLEIN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1491
Mailing Address - Country:US
Mailing Address - Phone:709-011-0445
Mailing Address - Fax:
Practice Address - Street 1:1535 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-1491
Practice Address - Country:US
Practice Address - Phone:570-901-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001312L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0619284Medicaid
807793OtherBLSHIEL
PA0619284Medicaid
PA435629Medicare PIN
PAT28807Medicare UPIN