Provider Demographics
NPI:1033114350
Name:KANTOROSINSKI, MIROSLAW (DC)
Entity Type:Individual
Prefix:DR
First Name:MIROSLAW
Middle Name:
Last Name:KANTOROSINSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3155
Mailing Address - Country:US
Mailing Address - Phone:978-741-3477
Mailing Address - Fax:978-744-7757
Practice Address - Street 1:407 ESSEX ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3155
Practice Address - Country:US
Practice Address - Phone:978-741-3477
Practice Address - Fax:978-744-7757
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA354-33OtherHARVARD PILGRIM HEALTH CA
MA715139OtherTUFTS
MA1613588Medicaid
MA1613588Medicaid