Provider Demographics
NPI:1396860243
Name:INFANTINO, ANTHONY J (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:INFANTINO
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 1:4727 E UNION HILLS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3387
Mailing Address - Country:US
Mailing Address - Phone:602-866-8100
Mailing Address - Fax:602-866-8979
Practice Address - Street 1:4727 E UNION HILLS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3387
Practice Address - Country:US
Practice Address - Phone:602-866-8100
Practice Address - Fax:602-866-8979
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU62602Medicare UPIN
AZZDC5269Medicare ID - Type Unspecified