Provider Demographics
NPI:1043530249
Name:ANTOS, DORIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:ANTOS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:ANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:569 HEALTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1498
Mailing Address - Country:US
Mailing Address - Phone:386-258-9800
Mailing Address - Fax:
Practice Address - Street 1:569 HEALTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1498
Practice Address - Country:US
Practice Address - Phone:386-258-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor