Healthcare Provider Details

I. General information

NPI: 1013105162
Provider Name (Legal Business Name): CANTER CHIROPRACTIC LIFE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E 4TH ST
DOVER OH
44622-2923
US

IV. Provider business mailing address

127 E 4TH ST
DOVER OH
44622-2923
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-2236
  • Fax: 330-343-2300
Mailing address:
  • Phone: 330-343-2236
  • Fax: 330-343-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1176
License Number StateOH

VIII. Authorized Official

Name: DR. KENNETH WARREN CANTER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 330-343-2236