Provider Demographics
NPI:1447372834
Name:KANE CHIROPRACTIC PSC
Entity type:Organization
Organization Name:KANE CHIROPRACTIC PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-949-0900
Mailing Address - Street 1:3602 NORTHGATE CT
Mailing Address - Street 2:STE 17
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6417
Mailing Address - Country:US
Mailing Address - Phone:812-949-0900
Mailing Address - Fax:812-949-0300
Practice Address - Street 1:3602 NORTHGATE CT
Practice Address - Street 2:STE 17
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6417
Practice Address - Country:US
Practice Address - Phone:812-949-0900
Practice Address - Fax:812-949-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000319108OtherANTHEM
IN216320Medicare ID - Type Unspecified
000000319108OtherANTHEM