Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | F5653642 | MH |
NPI | 1083217988 |
---|---|
Provider Name | Nicholas Antonelli |
First Address | Miami, FL 33137-4462 |
Second Address | Miami, FL 33137-4462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2020 |
Last Update Date | 21/11/2020 |