Provider Demographics
NPI:1710915079
Name:KANTNER, RONALD DARYL (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DARYL
Last Name:KANTNER
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 1:801 BREWFIELD
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895
Mailing Address - Country:US
Mailing Address - Phone:419-738-4373
Mailing Address - Fax:419-738-3780
Practice Address - Street 1:801 BREWFIELD
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895
Practice Address - Country:US
Practice Address - Phone:419-738-4373
Practice Address - Fax:419-738-3780
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48560Medicare UPIN
OHKA0596693Medicare ID - Type Unspecified