Healthcare Provider Details

I. General information

NPI: 1679146419
Provider Name (Legal Business Name): ANTONIO NATURAL HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 18TH AVE STE 5
STURGEON BAY WI
54235-3207
US

IV. Provider business mailing address

1034 TACOMA BEACH RD
STURGEON BAY WI
54235-1660
US

V. Phone/Fax

Practice location:
  • Phone: 920-818-1234
  • Fax:
Mailing address:
  • Phone: 920-818-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ORVILLE A. ANTONIO
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 920-818-1234