Provider Demographics
NPI:1679146419
Name:ANTONIO NATURAL HEALING, LLC
Entity Type:Organization
Organization Name:ANTONIO NATURAL HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-818-1234
Mailing Address - Street 1:1034 TACOMA BEACH RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1660
Mailing Address - Country:US
Mailing Address - Phone:920-818-1234
Mailing Address - Fax:
Practice Address - Street 1:253 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2500
Practice Address - Country:US
Practice Address - Phone:920-818-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service