Provider Demographics
NPI:1790837730
Name:ADAM CANTOR PROFESSIONAL CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:ADAM CANTOR PROFESSIONAL CHIROPRACTIC CORP.
Other - Org Name:CANTOR CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:415-454-9600
Mailing Address - Street 1:754 SIR FRANCIS DRAKE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1933
Mailing Address - Country:US
Mailing Address - Phone:415-454-9600
Mailing Address - Fax:415-454-3509
Practice Address - Street 1:754 SIR FRANCIS DRAKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1933
Practice Address - Country:US
Practice Address - Phone:415-454-9600
Practice Address - Fax:415-454-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0028460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0284601OtherMEDICARE PTAN
CAZZZ05059ZOtherMEDICARE PTAN