Provider Demographics
NPI:1215238498
Name:KK CHIROPRACTIC CARE PC
Entity type:Organization
Organization Name:KK CHIROPRACTIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ELIEZER
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-207-1559
Mailing Address - Street 1:11880 BUSTLETON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2538
Mailing Address - Country:US
Mailing Address - Phone:215-207-1559
Mailing Address - Fax:
Practice Address - Street 1:11880 BUSTLETON AVE STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2538
Practice Address - Country:US
Practice Address - Phone:215-207-1559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005275-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA688402OtherHIGHMARK BLUE SHIELD
PA9599644OtherAETNA
PA1131426OtherASH