Provider Demographics
NPI:1003191362
Name:ANTONIOTTI, KATE S (DC)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:S
Last Name:ANTONIOTTI
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 1:1820 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1998
Mailing Address - Country:US
Mailing Address - Phone:269-344-5551
Mailing Address - Fax:269-344-0094
Practice Address - Street 1:1820 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1998
Practice Address - Country:US
Practice Address - Phone:269-344-5551
Practice Address - Fax:269-344-0094
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002607A111N00000X
MI2301010165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201061610AMedicaid
IN201061610AMedicaid
IN201061610AMedicaid
MIM40060441Medicare PIN