Provider Demographics
NPI:1134587173
Name:ANTONELLI, MATTHEW J (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:ANTONELLI
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 1:115 COMMONS DR STE D
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9264
Mailing Address - Country:US
Mailing Address - Phone:980-444-0060
Mailing Address - Fax:
Practice Address - Street 1:115 COMMONS DR STE D
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9264
Practice Address - Country:US
Practice Address - Phone:980-444-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor