Provider Demographics
NPI:1447611504
Name:KANTAREVIC, KARLY M A (DC)
Entity type:Individual
Prefix:DR
First Name:KARLY
Middle Name:M A
Last Name:KANTAREVIC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 CZECH LN NE STE A4
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2334
Mailing Address - Country:US
Mailing Address - Phone:319-389-5885
Mailing Address - Fax:
Practice Address - Street 1:4330 CZECH LN NE
Practice Address - Street 2:STE A4
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2334
Practice Address - Country:US
Practice Address - Phone:319-389-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2022-01-11
Deactivation Date:2021-12-20
Deactivation Code:
Reactivation Date:2022-01-05
Provider Licenses
StateLicense IDTaxonomies
IA081798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor