Provider Demographics
NPI:1629063078
Name:ANTONIOTTI, DAVID SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:ANTONIOTTI
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 1:1820 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1998
Mailing Address - Country:US
Mailing Address - Phone:269-344-5551
Mailing Address - Fax:269-344-0094
Practice Address - Street 1:1820 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1998
Practice Address - Country:US
Practice Address - Phone:269-344-5551
Practice Address - Fax:269-344-0094
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDA002675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OC95025OtherBLUE CROSS BLUE SHIELD
MI95OC95025OtherMESSA
MIP88849OtherBLUE CARE NETWORK
MIT32954Medicare UPIN
MI95OC95025OtherMESSA