Provider Demographics
NPI:1689608788
Name:ANTOINE, BETH (DC, ATC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 W JOHNSON ST
Mailing Address - Street 2:UNIT #4
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-3417
Mailing Address - Country:US
Mailing Address - Phone:717-448-0106
Mailing Address - Fax:
Practice Address - Street 1:504 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2235
Practice Address - Country:US
Practice Address - Phone:715-426-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0037602255A2300X
WI5127-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer