Provider Demographics
NPI:1821008103
Name:ASHLEY ANTONOFF, P.S.
Entity Type:Organization
Organization Name:ASHLEY ANTONOFF, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTONOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-883-2543
Mailing Address - Street 1:14777 NE 40TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3300
Mailing Address - Country:US
Mailing Address - Phone:425-883-2543
Mailing Address - Fax:425-867-1109
Practice Address - Street 1:14777 NE 40TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3300
Practice Address - Country:US
Practice Address - Phone:425-883-2543
Practice Address - Fax:425-867-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60211316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8851573Medicare PIN