Healthcare Provider Details

I. General information

NPI: 1639573280
Provider Name (Legal Business Name): ELLA KALANTAROV D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 US HIGHWAY 1
JUNO BEACH FL
33408-1404
US

IV. Provider business mailing address

6199 RIVERWALK LN UNIT 5
JUPITER FL
33458-7906
US

V. Phone/Fax

Practice location:
  • Phone: 561-626-6711
  • Fax: 561-626-6733
Mailing address:
  • Phone: 646-463-4031
  • Fax: 561-626-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: