Healthcare Provider Details

I. General information

NPI: 1740281856
Provider Name (Legal Business Name): BRUCE R KAHN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6-16 E BLACKWELL ST
DOVER NJ
07801-4654
US

IV. Provider business mailing address

6-16 E BLACKWELL ST
DOVER NJ
07801-4654
US

V. Phone/Fax

Practice location:
  • Phone: 973-989-1200
  • Fax: 973-989-1201
Mailing address:
  • Phone: 973-989-1200
  • Fax: 973-989-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC02559
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: