=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710005061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN S KANTOR DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 MAIN ST
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06880-3216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-226-7722
-----------------------------------------------------
Fax | 206-226-1625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 GRIST MILL LN
-----------------------------------------------------
City | WESTPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06880-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-255-5589
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 000439
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------