Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4288 | OH |
N | 111NN1001X | Nutrition | 4288 | OH |
N | 111NR0200X | Radiology | 4288 | OH |
N | 213ER0200X | Radiology | 4288 | OH |
N | 111NR0400X | Rehabilitation Chiropractor | 4288 | OH |
N | 111NS0005X | Chiropractic Sports Physician | 4288 | OH |
NPI | 1366706277 |
---|---|
Provider Name | Dr. Anthony Joseph Biondillo III |
First Address | Broadview Heights, OH 44147-3390 |
Second Address | Broadview Heights, OH 44147-4037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 26/06/2012 |