Healthcare Provider Details

I. General information

NPI: 1689608788
Provider Name (Legal Business Name): BETH ANTOINE DC, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S MAIN ST
RIVER FALLS WI
54022-2235
US

IV. Provider business mailing address

376 W JOHNSON ST UNIT #4
RIVER FALLS WI
54022-3417
US

V. Phone/Fax

Practice location:
  • Phone: 715-426-4774
  • Fax:
Mailing address:
  • Phone: 717-448-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003760
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5127-12
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: