Provider Demographics
NPI:1700813458
Name:KAN, PETER (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KAN
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 1:3336 E. CHANDLER HEIGHTS BLVD.
Mailing Address - Street 2:BUILDING 4 SUITE 123
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:480-988-6269
Mailing Address - Fax:480-988-6271
Practice Address - Street 1:3336 E. CHANDLER HEIGHTS BLVD.
Practice Address - Street 2:BUILDING 4 SUITE 123
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-988-6269
Practice Address - Fax:480-988-6271
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor