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General NPI Number Information
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NPI Number | 1215238498
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Entity Type | Organization
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Legal Business Name | KK CHIROPRACTIC CARE PC
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 11880 BUSTLETON AVE STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2538
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Country | US
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Telephone | 215-207-1559
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Fax |
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Provider Business Mailing Address
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Address Line | 11880 BUSTLETON AVE STE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2538
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Country | US
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Telephone | 215-207-1559
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. EDWARD ELIEZER KANTOR
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Credential | DC
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Telephone | 215-207-1559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC-005275-L
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License Number State | PA
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