Provider Demographics
NPI:1851696165
Name:ANTONUCCI, MATTHEW MICHAEL (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:ANTONUCCI
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 WHIPPLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8900
Mailing Address - Country:US
Mailing Address - Phone:843-882-5433
Mailing Address - Fax:
Practice Address - Street 1:874 WHIPPLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8900
Practice Address - Country:US
Practice Address - Phone:843-882-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3613111NN0400X, 111NN1001X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor