Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | MC04876 | NJ |
N | 111NR0400X | Rehabilitation Chiropractor | MC04876 | NJ |
NPI | 1366578213 |
---|---|
Provider Name | Dr. Douglas Kaner |
First Address | Fair Lawn, NJ 07410-1583 |
Second Address | Fair Lawn, NJ 07410-1583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MC004876 | LICENSE NUMBER (01) | NJ |
U70315 | (02) | NJ |