Provider Demographics
NPI:1417032632
Name:ANTONELLI, DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:ANTONELLI
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 1:2575 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5613
Mailing Address - Country:US
Mailing Address - Phone:908-688-7373
Mailing Address - Fax:908-688-8049
Practice Address - Street 1:2575 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5613
Practice Address - Country:US
Practice Address - Phone:908-688-7373
Practice Address - Fax:908-688-8049
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00425400111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician