Provider Demographics
NPI:1952343972
Name:ANTONUCCI, THOMAS FRANK (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANK
Last Name:ANTONUCCI
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NOEL DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1522
Mailing Address - Country:US
Mailing Address - Phone:716-481-3458
Mailing Address - Fax:
Practice Address - Street 1:7950 SALTSBURG RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-1974
Practice Address - Country:US
Practice Address - Phone:412-793-3700
Practice Address - Fax:412-793-2770
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010509-1111N00000X
PADC009627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA127532YVWOtherPTAN
PA1021436220001Medicaid
PA1021436220001Medicaid