Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH0002796 | FL |
NPI | 1407863988 |
---|---|
Provider Name | Dr. James C Antos |
First Address | Daytona Beach, FL 32114-1498 |
Second Address | Daytona Beach, FL 32114-1498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 06/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T55744 | (02) | FL |