Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1205 | MA |
NPI | 1215926589 |
---|---|
Provider Name | Dr. Peter L Antonsen |
First Address | Amesbury, MA 01913 |
Second Address | Amesbury, MA 01913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T58447 | (02) |