Healthcare Provider Details

I. General information

NPI: 1790837730
Provider Name (Legal Business Name): ADAM CANTOR PROFESSIONAL CHIROPRACTIC CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 SIR FRANCIS DRAKE BLVD STE 2
SAN ANSELMO CA
94960-1933
US

IV. Provider business mailing address

754 SIR FRANCIS DRAKE BLVD STE 2
SAN ANSELMO CA
94960-1933
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-9600
  • Fax: 415-454-3509
Mailing address:
  • Phone: 415-454-9600
  • Fax: 415-454-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0028460
License Number StateCA

VIII. Authorized Official

Name: DR. ADAM HARRIS CANTOR
Title or Position: OWNER
Credential: D.C
Phone: 415-454-9600