Provider Demographics
NPI:1750541850
Name:KAGANOVICH, ITZHAK (DC)
Entity type:Individual
Prefix:
First Name:ITZHAK
Middle Name:
Last Name:KAGANOVICH
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 1:346 BASSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7217
Mailing Address - Country:US
Mailing Address - Phone:215-280-8229
Mailing Address - Fax:
Practice Address - Street 1:8400 BUSTLETON AVE
Practice Address - Street 2:STE 102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1918
Practice Address - Country:US
Practice Address - Phone:215-342-4100
Practice Address - Fax:215-342-4101
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor