Provider Demographics
NPI:1639573280
Name:KALANTAROV, ELLA (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:KALANTAROV
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 1:6199 RIVERWALK LN UNIT 5
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7906
Mailing Address - Country:US
Mailing Address - Phone:646-463-4031
Mailing Address - Fax:561-626-6733
Practice Address - Street 1:14100 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1404
Practice Address - Country:US
Practice Address - Phone:561-626-6711
Practice Address - Fax:561-626-6733
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor