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General NPI Number Information
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NPI Number | 1144521303
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Entity Type | Individual
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Provider Name | DAVID ANTONIO MEDINA D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 69 HUSTONVILLE ST.
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City | LIBERTY
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State | KY
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Zip | 42539
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Country | US
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Telephone | 606-787-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 629 CALEF HWY 103
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City | EPPING
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State | NH
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Zip | 03042-1614
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Country | US
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Telephone | 603-679-3222
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Fax | 603-679-3222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 950
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License Number State | NH
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