Provider Demographics
NPI:1639291024
Name:KANE, DOUGLAS T (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:T
Last Name:KANE
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 1:3602 NORTHGATE CT
Mailing Address - Street 2:STE 17
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6417
Mailing Address - Country:US
Mailing Address - Phone:812-949-0900
Mailing Address - Fax:812-949-0300
Practice Address - Street 1:3602 NORTHGATE CT
Practice Address - Street 2:STE 17
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6417
Practice Address - Country:US
Practice Address - Phone:812-949-0900
Practice Address - Fax:812-949-0300
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000319108OtherANTHEM
IN216320AMedicare ID - Type Unspecified
U33747Medicare UPIN