Healthcare Provider Details

I. General information

NPI: 1689002099
Provider Name (Legal Business Name): KANTER CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 MONTEZUMA AVE 531
SANTA FE NM
87501-2835
US

IV. Provider business mailing address

369 MONTEZUMA AVE 531
SANTA FE NM
87501-2835
US

V. Phone/Fax

Practice location:
  • Phone: 352-636-9638
  • Fax:
Mailing address:
  • Phone: 352-636-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number998
License Number StateNM

VIII. Authorized Official

Name: REBEKAH KANTER
Title or Position: PRESIDENT
Credential: DOM
Phone: 352-636-9638