Provider Demographics
NPI:1760412324
Name:KAHN, LAURENCE SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:SCOTT
Last Name:KAHN
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 1:1200 CENTRAL AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2683
Mailing Address - Country:US
Mailing Address - Phone:847-251-1120
Mailing Address - Fax:847-251-1120
Practice Address - Street 1:1200 CENTRAL AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2683
Practice Address - Country:US
Practice Address - Phone:847-251-1120
Practice Address - Fax:847-251-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93158Medicare UPIN