Provider Demographics
NPI:1366578213
Name:KANER, DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:KANER
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 1:23-08 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1583
Mailing Address - Country:US
Mailing Address - Phone:201-794-4500
Mailing Address - Fax:201-794-4502
Practice Address - Street 1:23-08 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1583
Practice Address - Country:US
Practice Address - Phone:201-794-4500
Practice Address - Fax:201-794-4502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04876111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMC004876OtherLICENSE NUMBER
NJU70315Medicare UPIN
NJMC004876OtherLICENSE NUMBER