Provider Demographics
NPI:1497977052
Name:STEPHEN A. ANTINORO, D.C.
Entity Type:Organization
Organization Name:STEPHEN A. ANTINORO, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANTINORO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-467-5428
Mailing Address - Street 1:2100 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963
Mailing Address - Country:US
Mailing Address - Phone:814-467-5428
Mailing Address - Fax:
Practice Address - Street 1:2100 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963
Practice Address - Country:US
Practice Address - Phone:814-467-5428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004330-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1500214OtherGATEWAY
PA104779OtherUNISON
PA0012510050001Medicaid
PA1500214OtherGATEWAY
PAAN685053Medicare ID - Type Unspecified