Provider Demographics
NPI:1013105162
Name:CANTER CHIROPRACTIC LIFE CENTER INC
Entity Type:Organization
Organization Name:CANTER CHIROPRACTIC LIFE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:CANTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-343-2236
Mailing Address - Street 1:127 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2923
Mailing Address - Country:US
Mailing Address - Phone:330-343-2236
Mailing Address - Fax:330-343-2300
Practice Address - Street 1:127 E 4TH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2923
Practice Address - Country:US
Practice Address - Phone:330-343-2236
Practice Address - Fax:330-343-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48411Medicare UPIN
OHCA9275001Medicare PIN