Provider Demographics
NPI:1497053805
Name:ANTONOFF, ASHLEY MARLENE (DC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:MARLENE
Last Name:ANTONOFF
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 1:14777 NE 40TH ST
Mailing Address - Street 2:#102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3300
Mailing Address - Country:US
Mailing Address - Phone:425-883-2543
Mailing Address - Fax:425-867-1109
Practice Address - Street 1:14777 NE 40TH ST
Practice Address - Street 2:#102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3300
Practice Address - Country:US
Practice Address - Phone:425-883-2543
Practice Address - Fax:425-867-1109
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60211316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH60211316OtherWASHINGTON STATE CHIROPRACTIC LICENSE