Provider Demographics
NPI:1629102231
Name:ANTMAN, LORI LINETTE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LINETTE
Last Name:ANTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FORT CROCKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-5962
Mailing Address - Country:US
Mailing Address - Phone:409-935-4467
Mailing Address - Fax:
Practice Address - Street 1:4623 FORT CROCKETT BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-5962
Practice Address - Country:US
Practice Address - Phone:409-762-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT11969Medicare UPIN
TX601-703Medicare ID - Type Unspecified