=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679146419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTONIO NATURAL HEALING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2021
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 N 18TH AVE STE 5
-----------------------------------------------------
City | STURGEON BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54235-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-818-1234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1034 TACOMA BEACH RD
-----------------------------------------------------
City | STURGEON BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54235-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-818-1234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. ORVILLE A. ANTONIO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 920-818-1234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------