Provider Demographics
NPI:1558432724
Name:KANTOR, DORON SAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:DORON
Middle Name:SAUL
Last Name:KANTOR
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 1:9528 STATE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2279
Mailing Address - Country:US
Mailing Address - Phone:360-659-6554
Mailing Address - Fax:360-653-4882
Practice Address - Street 1:9528 STATE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-2279
Practice Address - Country:US
Practice Address - Phone:360-659-6554
Practice Address - Fax:360-653-4882
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8867907Medicare PIN