Provider Demographics
NPI:1538681648
Name:ANTONETTI, KENNETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:ANTONETTI
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 1:650 CENTRAL AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-444-6165
Mailing Address - Fax:941-493-5088
Practice Address - Street 1:650 CENTRAL AVE
Practice Address - Street 2:STE 3
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-444-6165
Practice Address - Fax:941-493-5088
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor