Provider Demographics
NPI:1992032510
Name:TANTILLO, RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TANTILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8466 NORTHCLIFFE BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1140
Mailing Address - Country:US
Mailing Address - Phone:352-666-2222
Mailing Address - Fax:352-683-7284
Practice Address - Street 1:8466 NORTHCLIFFE BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1140
Practice Address - Country:US
Practice Address - Phone:352-666-2222
Practice Address - Fax:352-683-7284
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4540WMedicare UPIN