Provider Demographics
NPI:1164521225
Name:KANTOROSINSKI CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KANTOROSINSKI CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIROSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOROSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-741-3477
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA44806OtherHARVARD PILGRIM HEALTH
721595OtherTUFTS
3136810OtherAETNA
Y35054Medicare ID - Type Unspecified