MEDICARE: ITZHAK KAGANOVICH D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC010142	PA

General Provider Information

NPI Number	:	1750541850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITZHAK KAGANOVICH D.C.

Provider Business Mailing Address
First Line	:	346 BASSWOOD CIR
Second Line	:
City	:	FEASTERVILLE TREVOSE
State	:	PA
Zip	:	19053-7217
Country	:	US
Telephone Number	:	215-280-8229
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 BUSTLETON AVE
Second Line	:	STE 102
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1918
Country	:	US
Telephone Number	:	215-342-4100
Fax Number	:	215-342-4101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/28/2012

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