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General NPI Number Information
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NPI Number | 1841487436
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Entity Type | Individual
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Provider Name | DANE B. KOHL D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 4550 E BELL RD BLDG 6 SUITE 152
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City | PHOENIX
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State | AZ
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Zip | 85032-9306
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Country | US
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Telephone | 602-258-9663
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Fax |
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Provider Business Mailing Address
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Address Line | 20632 N 9TH ST
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City | PHOENIX
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State | AZ
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Zip | 85024-4109
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Country | US
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Telephone | 480-298-9956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7860
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4552
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License Number State | AZ
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