Provider Demographics
NPI:1518558568
Name:ANTIGNOLO, TYLER JACOB (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JACOB
Last Name:ANTIGNOLO
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 1:1395 E ELDORADO PKWY STE 800
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5533
Mailing Address - Country:US
Mailing Address - Phone:469-362-0511
Mailing Address - Fax:469-362-0541
Practice Address - Street 1:1395 E ELDORADO PKWY STE 800
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5533
Practice Address - Country:US
Practice Address - Phone:469-362-0511
Practice Address - Fax:496-362-0541
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor