Basic Information
Provider Information
NPI: 1740351915
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KANTOR
FirstName: YAEL
MiddleName: C.
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15811 AMBAUM BLVD SW
Address2: STE 110
City: BURIEN
State: WA
PostalCode: 981663066
CountryCode: US
TelephoneNumber: 2062428211
FaxNumber: 2062420162
Practice Location
Address1: 15811 AMBAUM BLVD SW
Address2: STE 110
City: BURIEN
State: WA
PostalCode: 981663066
CountryCode: US
TelephoneNumber: 2062428211
FaxNumber: 2062420162
Other Information
ProviderEnumerationDate: 11/10/2006
LastUpdateDate: 07/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000XCH00002485WAY Chiropractic ProvidersChiropractor 

No ID Information.


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