Healthcare Provider Details

I. General information

NPI: 1790668374
Provider Name (Legal Business Name): KENAN DORAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 GREEN FOREST LN STE 102
LUTZ FL
33558-5388
US

IV. Provider business mailing address

2540 GREEN FOREST LN STE 102
LUTZ FL
33558-5388
US

V. Phone/Fax

Practice location:
  • Phone: 813-575-3550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5946
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: