Provider Demographics
NPI:1477184760
Name:KANTOR, ALEXIS (DC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GEORGETOWN OVAL
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6804
Mailing Address - Country:US
Mailing Address - Phone:845-729-0462
Mailing Address - Fax:
Practice Address - Street 1:45 HARBOR DR
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7405
Practice Address - Country:US
Practice Address - Phone:845-729-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2181OtherCONNECTICUT CHIROPRACTOR LICENSE NUMBER