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General NPI Number Information
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NPI Number | 1487968772
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Entity Type | Organization
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Legal Business Name | ANTONINO ENTERPRISES LLC
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 211 COMMERCE ST
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City | CADIZ
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State | KY
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Zip | 42211-9225
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Country | US
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Telephone | 270-522-3957
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Fax |
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Provider Business Mailing Address
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Address Line | 211 COMMERCE ST
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City | CADIZ
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State | KY
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Zip | 42211-9225
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Country | US
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Telephone | 270-522-3957
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY THOMAS VITALE
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Credential | D.C.
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Telephone | 270-522-3957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 5157
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License Number State | KY
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